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They are typically commissioned by policy makers and practitioners to inform their decision making. They can also be a great method of determining the causal relationship between the intervention and its effects. However, they shouldn't be used as a substitute for explanatory studies.    The concept of pragmatism is controversial and there are doubts about whether pragmatic trials can replace explanatory tests or if they should serve as a complement to them. Schwartz and Lellouch1 proposed the distinction between explanation studies, which support the physiological hypothesis or clinical hypothesis, as well as pragmatic trials that aid in the practice and policy decision-making. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool attempted to define the characteristics of a pragmatic study that includes the recruitment, design, and delivery of the intervention and follow-up.    The number of pragmatic trials is increasing. A recent Medline query using the keywords pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs), returned 34 articles. These are highlighted in red on Figure 2. This suggests that the health sciences community is becoming more aware of the importance of pragmatic thinking. However, it is important to keep in mind that the majority of these studies were conducted in primary care settings. 

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