In reply: Ernst is concerned about the sham acupuncture procedure used in our trial.1 Although not universally agreed, the sham/placebo control we adopted has been described as best practice.2,3 The assumption that, without de-qi, participants would not be blinded is not supported by the literature. In fact, a sham procedure without de-qi was used in a recent trial reported by Ernst and colleagues on acupuncture for subacute stroke rehabilitation.4 In that study, as in ours, to increase the credibility of blinding, participants with previous experience of acupuncture were excluded, and those assessing the outcomes of treatment were blinded.
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