This discussion needs a reframing or a return to its original frame. It is crucial to apprehend the context when many people engage in asynchronous text exchanges.
RCTs were developed to test interventions within homogenous biological constructs. Petty and Bone proposed RCTs could be used to test interventions within homogenous clinical constructs.
This is no trivial modification from the original method.
I like to use the expression disease model to denote the biological construct that gives a disease its unique taxonomy. Such models must be capable of articulating the clinical presentation, the diagnostic workup, and plausible intervention targets. Clinical constructs are not disease models.
For instance, one may declare that “Strong Headache” is a clinical construct and then enroll 'Strong Headache" patients to test the same intervention in all patients, never caring about common biological mechanisms. This is the “Petty and Bone” approach to headaches.
The Petty and Bone modification is a scientific conjecture per se, on the realm of epistemology.
Refuting a conjecture that failed to provide valid predictions of the empirical world is the unavoidable duty of the scientist.