Adding the clinical framing, because it changes how the question reads. The honest answer is that the effect is real, the magnitude is contested, and the individual variation is larger than either. Those three things can all be true at once, and most arguments here are two people holding different parts of that.

PedsEndoPhilly said:

The honest answer is that the effect is real, the magnitude is contested, and the individual variation is larger than either.

Second this. Posting only so the count is not one.

PedsEndoPhilly said:

The honest answer is that the effect is real, the magnitude is contested, and the individual variation is larger than either.

There is a second half to this that has not been said yet. Read four things before the headline number. The population, because trial populations are selected and supported in ways that real cohorts are not. The comparator, because "better than placebo" and "better than the current standard" are different claims and get reported identically. The primary endpoint as pre-registered, because a secondary endpoint promoted after the fact is a hypothesis rather than a finding. And the completion rate, because a large effect in the half of participants who finished is a different result from a large effect in everybody enrolled.

Adding the numbers, since they settle part of this. For anyone reading later: the numbers in this thread are worth checking against a primary source before you act on them, including mine. Half the figures circulating in this community trace back to a secondary summary that dropped a qualifier.

A narrower follow-up, since the general answer is now clear:

How would you tell the difference between that and the alternative explanation?