In Acupuncture research, the demand for an rigorous “sham” procedure has been relentless, and difficult to satisfy.  To have a sham needle that doesn’t penetrate the skin is hard to pull off, but that is what is required.

Finally there is a call to subject surgery to the same standard.  To show that the actual surgery works better than a sham surgery.  The most high profile example of a surgery that was proven to be no better than sham was arthroscopy for meniscal repair.  This was one of the most common surgeries performed in the U.S.