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A specific critique arguing that when an RCT is too tightly controlled, too heavily randomized, or too isolated from real‑world conditions, almost any observed difference can be dismissed as a placebo effect—or conversely, the trial may fail to detect genuine effects because the artificial [environment] suppresses the contextual factors that make placebos (and treatments) work. This Hard Problem highlights the paradox of control: the more you control to eliminate bias, the more you may create an [environment] that is [irrelevant] to practice. It warns that excessive control does not simply increase validity; it may produce sterile findings that do not translate.
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