Yes, I agree. I think my point really is that clinical outcomes care about how the patient feels, while scientific outcomes (like whether your medicine works th

Yes, I agree. I think my point really is that clinical outcomes care about how the patient feels, while scientific outcomes (like whether your medicine works the way you think it does) usually does not. We got a lot of great medicine whose biomechanics we don’t really understand and whose trials don’t prove but definitely safely and significantly help people. A study just seeking to prove that your drug does the biomechanics it claims measures a placebo effect of zero if it is done correctly, because if you observe a placebo effect you’re not dealing with a biomechanically constrained outcome anymore. There isn’t really a viable alternative to evidence based medicine, it’s the only game in town. We just have to carefully decide what outcomes we care about and whether or not those outcomes (1) discourage scientific understanding of the underlying biomechanics of our drugs, by virtue of making black-boxedness acceptable and (2) are co-opted, via enemy action, by either conspiracy theorists sowing doubt in things like vaccines or moneyed interests who make mediocre drugs look good.