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It has been recognized as one of the top gaming platforms for casinos despite its relative infancy. The most recent releases include Wolves, a 5-reel video slot with a healthful RTP and impressive graphics. Its other notable titles are Wolf Gold and Chilli Heat. The purpose of pragmatic trials is to mimic real-life scenarios and to achieve the highest level of validity externally. They are typically ordered by policymakers and practitioners to inform their decisions. They can also be used to determine the causal relationship between an intervention and its results. They should not, however, be used to replace explanatory studies. The concept of pragmatism is controversial and there are questions about whether pragmatic trials should replace explanatory trials or complement them. Schwartz and Lellouch1 made an distinction between explanation-based studies, which prove a physiological hypothesis or clinical hypothesis, and pragmatic trials, which inform the practice and policy decision-making. They also suggested a framework for pragmatic trials, which they called PRECIS.2 This tool sought to define the features of a pragmatic trial that include the recruitment process, the design and delivery of the intervention, and follow-up. The number of pragmatic trials is increasing. 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 more sensitive to the issue of pragmatics. It is important to keep in mind that the majority of these studies were conducted in primary care settings.