No trial with a significant treatment effect is ever really blind. If 60% of the patients not in the trial are dying, while only 35% of the patients in the trial are dying (60% placebo + 10% treatment) then this will be obvious to all even if the trial is still nominally blinded.
One of the things you are supposed to do in trials is survey the patients and doctors after treatment to see if they knew if they were in the treatment or placebo arm.
Novartis deal on the rocks, page-103
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