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They should not, however be used to replace explanation studies.<br><br>The idea of pragmatism is controversial, and there are questions about whether pragmatic trials can replace explanatory tests or if they should serve as an addition to them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which validate the validity of a clinical or physiological hypothesis and pragmatic trials that inform the practice and policy decisions. They also proposed an approach to pragmatic trials, which they called PRECIS.2 This tool was designed to define the elements of a pragmatic trial, including recruitment, design and delivery of the intervention, as well as monitoring.<br><br>The number of pragmatic trials is growing. A recent Medline search using the terms pragmatic and naturalistic, restricted to randomized controlled trials (RCTs) resulted in 34 articles, which are shown in red in Figure 2. This is a sign that the health science community is becoming more sensitive to the issue of pragmatism. However, it is important to note that the majority of these trials were conducted in primary care settings.