No longer randomized though, so it brings in confounding factors. Which one then has to try to control for.

Doesn't really change your point, but I should clarify that what I said was wrong, it was anyone in the study could choose not to take the blinded pill that could be placebo or active, they were removed from the study, and were provided with the active experimental drug + compensation as to not punish them for giving or not giving their consent after being sufficiently informed of the risks of either choice.