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Despite its relatively young age it has already established itself as a premier gaming platform for casinos. Wolves is one of the latest games that is a 5-reel slot machine with a healthy RTP and impressive graphics. Other notable games include Wolf Gold and Chilli Heat. Pragmatic trials are designed to replicate real-life settings and achieve maximum external validity. They are usually ordered by policymakers and practitioners in order to inform their decisions. They can also be used to assess the cause-effect relationship of an intervention and its results. They should not, however, 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 the distinction between explanation trials, which confirm the validity of a clinical or physiological hypothesis as well as pragmatic trials that inform policy and practice decisions. They also proposed a framework called PRECIS for pragmatic trials.2 This tool attempted to define the characteristics of a pragmatic study that includes recruitment, design, delivery of the intervention, and follow-up. The number of pragmatic trials is growing. A recent Medline search using the terms pragmatic and naturalistic, restricted to controlled trials randomized to control (RCTs) resulted in 34 articles, shown in red in Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatic thinking. It is important to keep in mind, however, that the majority were conducted in primary care settings.