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Its software is designed to work with mobile devices and supports multiple languages. Despite its relative youth it has established itself as a leading gaming platform for casinos. Wolves is one of its latest releases that is a 5-reel slot machine that has a high RTP and stunning graphics. The other notable titles include Wolf Gold and Chilli Heat. Pragmatic trials are designed to replicate real-world situations and have the highest external validity. Usually, they are commissioned by policymakers and practitioners to help guide their decisions. They also provide a useful method to determine the cause-effect relationship between an intervention and its outcomes. They should, however, not, be used to replace explanatory studies. The concept of pragmatism 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 studies, which confirm a physiological hypothesis or clinical hypothesis, as well as pragmatic trials, which inform policy and practice decision-making. They also proposed the framework for pragmatic trials, dubbed PRECIS.2 This tool attempted to define the features of a practical trial that include the recruitment process, the design and delivery of the intervention, and follow-up. There is a growing increase in the number pragmatic trials that are published. A recent Medline search using the terms naturalistic and pragmatic, limited to controlled trials that are randomized (RCTs) produced 34 articles, which are shown in red in Figure 2. This suggests that the health sciences community is becoming more aware of the importance of pragmatic thinking. It is important to remember, however, that the majority of studies were conducted in primary care settings.