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The latest releases include Wolves, a 5-reel video slot with a healthful RTP and stunning graphics. Other notable titles include Wolf Gold and Chilli Heat. The goal of pragmatic trials is to simulate real-life situations and achieve maximum validity externally. They are usually requested by practitioners and policy makers to aid in their decision-making. They can also be a great method to determine the cause-effect relationship between an intervention and its outcomes. However, they should not be used in lieu for the use of explanation studies. The concept of pragmatism is controversial, and there are questions regarding whether pragmatic trials could be used to replace explanation tests or if they are an alternative to them. Schwartz and Lellouch1 suggested an distinction between explanation-based studies, which support a physiological hypothesis or clinical hypothesis, and pragmatic trials, which inform the practice and policy decision-making. They also proposed a framework called PRECIS for pragmatic trials.2 This tool attempted to define the elements of a pragmatic research study that includes recruitment, design, implementation of the intervention and follow-up. There is a positive increase in the number pragmatic trials published. A recent Medline query that used the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs) returned 34 articles. These are shown in red on Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatism. It is important to note, however, that the majority of studies were conducted in primary-care settings.