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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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