I find it a rather disturbing phenomenon, to be honest. Governments, scientists and media insist that we place enormous faith in the outputs of medical trials and studies. Anyone who expresses doubt about these is ostracised and forced to comply regardess. Yet every single one of them has to control for this entirely mysterious, inexplicable force that magically heals people with no actual medicine. This effect is so real, large and standard that it's mandated by law to take it into account yet we understand basically nothing about it (often even what the placebo was chosen to be is opaque), it's barely researched and the total lack of ability to explain it doesn't seem to bother anyone. Least of all regulators, who are meant to ensure the effect size of trials are correctly interpreted.
It feels like there's this enormous, sophisticated scientific edifice that can draw pictures of proteins and explain how they interact, and in the centre of it all is a giant rotating question mark that everyone by convention ignores and pretends isn't there.
It's not like they don't try to figure it out. But as you said:
>> "This effect is so real, large and standard that it's mandated by law to take it into account yet we understand basically nothing about it"
What would you prefer doctors do? Not use life-saving and life-improving treatments that are proven more effective than placebo after rigorous trials just because they don't understand it 100%?
The problem is we currently tend to ignore certain biases in our process which are known to introduce errors. Once it becomes a recommended medical practice that medical professionals use, medical opinion often trumps common sense and patients have trouble defending themselves even when they, personally, are certain this is harming them.
Doctors will outright suggest you are mentally ill and need to see a therapist if your life is on the line, you aren't satisfied with their course of treatment and you question what they are doing and/or express concerns that this could kill you. Once they more or less declare you crazy for questioning them, you lose even more control over your body, your health, your life and your right to actively make decisions for yourself.
There is definitely room for improvement in our current process.
That western medicine is often full of itself, deeply [insert -ism or -phobia] in practice, and frequently misguided is all very true and reasonable criticism. The person I replied to was essentially writing off the entire foundation of western medicine because doctors and medical science people don't always fully understand why things work.
It would be like someone writing off Newtonian physics before quantum mechanics was a thing because a lot more of the how wasn't yet understood. The practice of medicine has moved past the "if she floats, she's made of wood, and that means she's a witch" phase even if it still sees anyone other than cishet white dudes as witches.
I don't know. But how can we really claim things are "proven" or the trials are "rigorous" when they literally assume some sort of magic in their fundamental design? I mean we should at the very least dial down our certainty in medical claims until scientists can satisfactorily explain why they think new age woo/homeopathy/etc is beyond the pale neanderthal stupidity, up until the moment it's relabelled "placebo" when suddenly it can work.
I mean we're in an environment where the US President is forcing an entire nation to take an experimental medical treatment on the back of (failed!) trials, simply because politician's faith in "science" and the medical establishment is 100% unshakeable. Largely because scientists themselves hardly seem to admit to the true levels of uncertainty in their own work (replication crisis etc). There's a huge mismatch between people's perception of study rigor and "sometimes people think themselves better lol magic innit", which is basically the state of our understanding of the placebo effect.
It feels like there's this enormous, sophisticated scientific edifice that can draw pictures of proteins and explain how they interact, and in the centre of it all is a giant rotating question mark that everyone by convention ignores and pretends isn't there.