You aren't reading it right.

  new Sanitizer({})

This Sanitizer will allow everything by default, but setHTML will still block elements/attributes that can lead to XSS.

You might want something like:

  new Sanitizer({ replaceWithChildrenElements: ["h1"], elements: [], attributes: [] })

This will replace <h1> elements with their children (i.e. text in this case), but disallow all other elements and attributes.

i think the use case for setHTML is for user content that contains rich text and to display that safely. so this is not an alternative for escaping text or inserting text into the DOM but rather a method for displaying rich text. for example maybe you have an editor that produces em, and strong tags so now you can just whitelist those tags and use setHTML to safely put that rich text into the DOM without worrying about all the possible HTML parsing edge cases.