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Let me be among the first to offer support for more Pragmatic Clinical Trials as a functional way to improve health care delivery and economics in the US and abroad. As more Exploratory Trials head to the East to offer Sponsors and CROs economies of scale, those of us in the West may be wise to ponder the applicability of such work with indigenous populations. To wit, US Obesity rates are climbing above 30% in several US States, so what efficacy can be expected in populations where Metabolic Syndromes are at epidemic levels? There are manifold benefits to leveraging Electronic Health Records in Real World/Pragmatic clinical settings that are compelling.