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It has been recognized as one of the leading gaming platforms in the casino industry despite its relatively young age. Wolves is one of the most recent releases, a 5-reel slot machine with a hefty RTP and stunning graphics. Other notable titles include Wolf Gold and Chilli Heat. Pragmatic trials aim to mimic real-life situations and attain maximum external validity. They are usually commissioned by policymakers and practitioners to inform their decisions. They can also be used to determine the causal relationship between an intervention with its outcomes. However, they shouldn't be used in lieu for the use of explanation studies. The idea of pragmatism is controversial and there are doubts about whether pragmatic trials should replace tests for explanations or if they should be a complement to them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which validate a physiological or clinical hypothesis as well as pragmatic trials, which guide the practice and policy decisions. They also proposed the framework for pragmatic trials, called PRECIS.2 This tool sought to define the elements of a pragmatic study, including the recruitment process, the design and implementation of the intervention, as well as the follow-up. There is a positive trend in the number of pragmatic trials published. A recent Medline search using the words pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs) returned 34 articles. These are shown in red on Figure 2. This is a sign that the health science community is becoming increasingly sensitized to the issue of pragmatism. However, it is important to remember that the majority of these studies were conducted in primary care settings.