There is always the third possibility: random statistical fluctuations make one option seem better than the other when this is not true. Which breaks down to t

There is always the third possibility: random statistical fluctuations make one option seem better than the other when this is not true. Which breaks down to two more possibilities in relation to placebos: 1. Both are as effective as placebo. 2. Both are equally effective and better than placebo. 4. The seemingly worse option is actually better than placebo (but statistical fluctuations masked this). Given that there are very few studies and that publication bias is a thing, these possibilities are conceivably more likely than the p-value would lead one to believe. The benefit of placebo testing in the first place is that you end up with a simpler possibility matrix (the neither is better than the other outcome also breaks down into a whole slew of cases).