The Pragmatic Turn in Clinical Research: in Search for the Real World

How does knowledge obtained in clinical trials apply to the actual treatment of patients? This question has recently acquired a new significance amidst complaints about the limited ability of trial results to improve clinical practice. Pragmatic clinical trials have been advocated to address this problem. In this article, I trace the emergence of the pragmatic turn in clinical research, starting from the first mention of 'pragmatic trial' in 1967, and analyse the changes to how such trials have been conceived. I argue that contemporary version of pragmatism in clinical trials risks missing the mark by focusing exclusively on establishing similarity between the trial and the clinic for the purpose of greater generalizability. This focus eclipses the move for carefully aligning medical experimentation with conditions, needs and concerns in the clinic aimed at greater usefulness.