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However, they shouldn't be used to substitute for the use of explanation studies.<br><br>The pragmatism idea is controversial and there are concerns about whether pragmatic trials should replace explanatory tests or if they should be an addition to them. Schwartz and Lellouch1 suggested an distinction between explanation-based studies, which confirm a physiological hypothesis or clinical hypothesis, as well as pragmatic trials that aid in the practice and policy decision-making. They also suggested an approach to pragmatic trials, called PRECIS.2 This tool attempted to define the elements of a practical trial that include the recruitment process, the design and delivery of the intervention, as well as monitoring.<br><br>There is a growing increase in the number pragmatic trials that have been published. A recent Medline search using the keywords naturalistic and pragmatic, limited to randomized controlled trials (RCTs), yielded 34 articles, shown in red in Figure 2. 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