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Despite its relative youth, it has already established itself as a leading gaming platform for casinos. Wolves is one of the latest games, a 5-reel slot machine that has a high RTP and impressive graphics. Other notable titles include Wolf Gold and Chilli Heat. The aim of pragmatic trials is to simulate real-life scenarios and gain maximum credibility externally. Usually, they are ordered by policymakers and practitioners in order to guide their decisions. They also provide a useful way to identify the causality between an intervention and its outcomes. However, they shouldn't be used as a substitute for the use of explanation trials. The idea of pragmatism is controversial and there are doubts about whether pragmatic trials should replace explanatory tests or if they should serve as an addition to them. Schwartz and Lellouch1 suggested the distinction between explanation studies, which confirm the physiological hypothesis or clinical hypothesis, and pragmatic trials, that inform the decision-making process for policy and practice. They also suggested a framework dubbed PRECIS for pragmatic trials.2 The tool was designed to define the characteristics of a pragmatic study that includes recruitment, design, delivery of the intervention and follow-up. There is a growing increase in the number of pragmatic trials that are published. A recent Medline search using the keywords pragmatic and naturalistic, restricted to controlled trials that are randomized (RCTs), yielded 34 articles, shown in red in Figure 2. This suggests that the health sciences community has become more aware of the importance of pragmatic thinking. It is important to keep in mind that the majority were conducted in primary-care settings.