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Another example of a trial that is pragmatic is the Home Blood Pressure Management (HBPM) study, which employed different investigators and participants from different geographical regions. This kind of heterogeneity, that is crucial for a pragmatic trial to be reliable and to reduce bias in the results, is also necessary. Too much heterogeneity, however could cause issues with the design of the trial. Pragmatic Play, 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 Pragmatic Play's offices in Romania and Malta offer customers an authentic gambling experience, and a wide selection of virtual betting options. The company also hosts a variety of game shows that make online gambling exciting and interactive. Some of these shows feature live hosts, while others are hosted by famous personalities from the industry. 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Its software is designed to work on mobile devices and is compatible with different languages. Despite its relative youth, it has already established itself as a top gaming platform for casinos. Its latest releases include Wolves, a 5-reel video slot with a healthy RTP and impressive graphics. Other notable games include Wolf Gold and Chilli Heat. Pragmatic trials aim to mimic real-life situations and attain maximum external validity. They are typically ordered by policymakers and practitioners to guide their decisions. They can also be used to determine the causality of an intervention with its outcomes. However, they shouldn't be used as a substitute for the use of explanation studies. The concept of pragmatism is controversial, and there are questions about whether pragmatic trials can be used to replace explanation tests or if they are an addition to them. Schwartz and Lellouch1 made the distinction between explanation studies, which confirm the physiological hypothesis or clinical hypothesis, and pragmatic trials that aid in policy and practice decision-making. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool tried to define the elements of a practical study that includes the recruitment, design, and delivery of the intervention and its follow-up. The number of pragmatic trials is growing. A recent Medline query using the keywords pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs) returned 34 articles. They are displayed in red on Figure 2. This indicates that the health sciences community is becoming more aware of the importance of pragmatism. However, it is important to remember that the majority of these studies were conducted in primary care settings.