Stuart Nicholls, PhD, from the Clinical Epidemiology Program at the Ottawa Hospital Research Institute ,continues the discussion from his February 18 Grand Rounds presentation. This discussion with IMPACT Principal Investigator Susan Mitchell, MD, MPH answers questions from Dr. Nicholls's presentation on giving an overview of ethical issues raised by pragmatic randomized controlled trials (RCTs) and which derive from ongoing work to develop guidance for those designing and conducting pragmatic RCTs.