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The game also offers a Free Spins bonus with multipliers up to 500x your bet. A pragmatic trial that uses different investigators and participants from different geographical areas is the Home Blood Pressure Management study (HBPM). This kind of heterogeneity is required for practical trials to be valid and also helps to reduce the chance of bias in the results. However too much heterogeneity could lead to issues with the design of the trial. Pragmatic Play is one of the major players in the live casino market, offers a variety of classic table games such as Blackjack and Roulette. The live studios of the company in Romania and Malta provide a genuine gambling experience for players and offer a wide range of virtual betting options. The company has also developed numerous interactive game shows that make online gambling fun. Some of these shows have a live host, while others are hosted by celebrities from the industry. 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Schwartz and Lellouch1 suggested a distinction between explanatory trials, which confirm the clinical or physiological hypothesis as well as pragmatic trials, which guide policy and practice decisions. They also suggested the framework for pragmatic trials, dubbed PRECIS.2 This tool was designed to define the features of a pragmatic study that include the recruitment process, the design and implementation of the intervention, and the follow-up. The number of pragmatic trials is increasing. 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 is becoming more acquaint to the subject of pragmatism. However, it is important to keep in mind that the majority of these studies were conducted in primary care settings.