Hi Rodpf
When people are being observed by external people, they start paying more attention to what is being observed. In this case, the US participants who had the placebo/ vehicle may have been paying more attention to their skin acne management than the background population. This can result in variation in results of the Placebo across different populations. It is known as the Hawthorne effect:
https://en.wikipedia.org/wiki/Hawthorne_effect
Regards,
Matt
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