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Schwartz and Lellouch1 suggested the distinction between explanatory trials, which prove the clinical or physiological hypothesis and pragmatic trials, which guide the policy and practice of. They also proposed a framework for pragmatic trials, called PRECIS.2 This tool sought to define the characteristics of a pragmatic study that include the recruitment process, the design and delivery of the intervention, as well as follow-up. There is an encouraging increase in the number of pragmatic trials published. A recent Medline query using the keywords pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs) returned 34 articles. These are shown in red on Figure 2. This suggests that the health sciences community has become more aware of the importance of pragmatic thinking. It is important to remember, however, that the majority were conducted in primary-care settings.