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Schwartz and Lellouch1 made a distinction between explanatory studies, which support a physiological hypothesis or clinical hypothesis, as well as pragmatic trials, that inform the decision-making process for policy and practice. They also proposed a framework called PRECIS for pragmatic trials.2 This tool tried to define the traits of a practical study that includes recruitment, design, implementation of the intervention and its follow-up. There is an encouraging increase in the number pragmatic trials that have been published. A recent Medline search using the keywords pragmatic and naturalistic, restricted to controlled trials randomized to control (RCTs), yielded 34 articles, shown in red in Figure 2. This is a sign that the health science community is becoming increasingly sensitized to the issue of pragmatism. It is important to note, however, that the majority of these studies were conducted in primary care settings.