In some cases it can be hard to tell them apart. But take fever relief medications as an example. There’s no reporting at all, you measure the temperature difference before and after taking the pill. And yes, the placebo effect exists here and does lower temperature, but the medication is much more effective. There are even placebo surgeries to test the effectiveness of a surgery protocol.

A very good video on the subject: https://youtu.be/tefIopDJQBQ