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Despite its infancy it has already established itself as a premier gaming platform for casinos. The latest releases include Wolves which is a five-reel video slot with a healthful RTP and impressive graphics. Other notable titles include Wolf Gold and Chilli Heat. The goal of pragmatic trials is to replicate real-life scenarios and to achieve maximum credibility externally. They are usually requested by policy makers and practitioners to inform their decision making. They also provide a useful way to identify the causality between an intervention and its outcomes. However, they should not be used to replace explanation studies. The concept of pragmatism is controversial, and there are questions about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 made an distinction between explanation-based studies, which confirm the physiological hypothesis or clinical hypothesis, as well as pragmatic trials, which inform policy and practice decision-making. They also suggested a framework dubbed PRECIS for pragmatic trials.2 The tool was designed to define the traits of a practical study which includes recruitment, design, delivery of the intervention and follow-up. There is an encouraging increase in the number pragmatic trials that are published. A recent Medline query that used the words pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs) returned 34 articles. They are displayed in red on Figure 2. This suggests that the health sciences community has become more aware of the importance of pragmatism. It is important to note, however, that the majority of these studies were conducted in primary care settings.