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Schwartz and Lellouch1 suggested the distinction between explanatory trials, which validate the validity of a clinical or physiological hypothesis as well as pragmatic trials, which inform the policy and practice of. They also suggested a framework for pragmatic trials, which they called PRECIS.2 This tool sought to define the characteristics of a practical trial which includes the recruitment process, the design and delivery of the intervention, as well as monitoring. The number of pragmatic trials is increasing. A recent Medline search using the terms naturalistic and pragmatic, which was limited to controlled trials randomized to control (RCTs) resulted in 34 articles, which are shown in red in Figure 2. This is an indication that the health sciences community is becoming more sensitive to the subject of pragmatics. It is important to note, however, that the majority were conducted in primary-care settings.