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The latest releases include Wolves, a 5-reel video slot that has a healthy RTP and impressive graphics. Other notable games include Wolf Gold and Chilli Heat. Pragmatic trials aim to mimic real-life situations and attain maximum external validity. They are usually commissioned by practitioners and policy makers to aid in their decision-making. They can be used to determine the causal relationship between an intervention with its outcomes. However, they should not be used to replace explanatory studies. The pragmatism concept is controversial and there are concerns about whether pragmatic trials should replace explanatory trials or complement them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which validate a physiological or clinical hypothesis as well as pragmatic trials, which inform policy and practice decisions. They also proposed a framework called PRECIS for pragmatic trials.2 This tool attempted to define the elements of a practical study, including recruitment, design, implementation of the intervention and follow-up. The number of pragmatic trials is growing. A recent Medline search using the words pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs) returned 34 articles. These are highlighted in red on Figure 2. This is an indication that the health sciences community is becoming more acquaint to the subject of pragmatic thinking. It is important to note that the majority of these studies were conducted in primary care settings.