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Schwartz and Lellouch1 made an distinction between explanation-based studies, which confirm a physiological hypothesis or clinical hypothesis, as well as pragmatic trials, which inform the decision-making process for policy and practice. They also proposed the framework for pragmatic trials, called PRECIS.2 This tool was designed to define the characteristics of a practical trial, including the recruitment process, the design and delivery of the intervention, and follow-up. There is an encouraging increase in the number pragmatic trials published. A recent Medline search using the words pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs) returned 34 articles. These are shown in red on Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatic thinking. It is important to note that the majority of studies were conducted in primary-care settings.