Clearly a big part of these approaches is the affect of placebo. Placebo is also a big part of the impact of many parts of western medicine. In clinical trials

Clearly a big part of these approaches is the affect of placebo. Placebo is also a big part of the impact of many parts of western medicine. In clinical trials antidepressants barely outperform placebos for instance. You've raised a good point that this makes it even harder to determine how well something is working. Was it 100 percent placebo or did change take place outside of the effect of the placebo? However just because the placebo effect is present doesn't mean we should dismiss it out of hand. The term "scaling out" and a "boring environment" to me requires a treatment as simple as for instance setting a broken bone. A procedure like this is very easy to train someone to perform and there is relatively little in the way of differentiation between patients. An arm is an arm, it's very easy to see the problem as well as to see how a treatment is working. But for instance in the case of acupuncture or qi gong or yoga, it would be very hard to replicate on a large scale. The practitioner matters a huge amount, as does the exact condition of the patient. Is the patient actually trying ot do the yoga? Is the acupuncturist good (most aren't). What kind of yoga is the person doing? Is the yoga or qi gong teacher leading them in the right direction for their particular issue? It isn't nearly as simple as a routine medical procedure. I'm not saying that all of these treatments necessarily are effective. The issue I have is how quickly some are to dismiss treatments as not being backed up by evidence when the evidence will be very hard to come by, and ignoring the nuance involved. Personally my experience has led me to believe that acupuncture done by someone that knows what they are doing will work more than a placebo. The same certainly goes for qi gong in my personal experience.