The words "clinically significant" and "benefit" are not the same thing as the effect being real. To me it reads as if they are testing the hypothesis that a patient comes into ER with a sprained ankle and the doctor gives them this "new powerful prescription pain pill that just came out" and instead tricks them with a sugar pill. If this worked, I'm sure it would be used as much as possible. And the study you linked is simply confirming that PE is not an effective treatment for anything.

That's not the topic at hand here, which is "is the PE real?". For me it absolutely is.