Taking aim at one of the last bastions of live-animal training for medical students, a physicians' group that champions animal rights has called upon the Johns Hopkins University to stop using live pigs to teach operating room techniques.
Calling the practice inhumane and unnecessary, the Washington-based Physicians Committee for Responsible Medicine notes that Hopkins is one of just two top-tier medical schools still convening live-animal labs.
"The ethical argument is that you should not use sentient creatures to our purposes unnecessarily," said Dr. John J. Pippin, a Dallas cardiologist affiliated with the group. "The reasons to use live animals, whatever they were, are no longer valid."
With Case Western Reserve University's decision to hold its last live-pig labs this semester, Hopkins will be the lone holdout among medical schools in the top 20 in the annual U.S. News & World Report ranking.
Overall, just 10 of the nation's 126 M.D.-granting medical schools use live animals during surgical rotations, according to the animal rights group. A larger number of teaching hospitals use animals to train postgraduate surgical residents, and animals are widely used to test new medical devices and surgical techniques.
For its part, Hopkins has no plans to end the use of live pigs, despite a flood of e-mails from animal rights activists and an editorial in The Johns Hopkins News-Letter, the undergraduate newspaper.
"I can't change their feelings, but we'd want them to understand that we really do think it's important in surgical training," said Dr. Julie Freischlag, director of surgery at the Johns Hopkins School of Medicine.
Like most of their peers nationwide, Hopkins students practice basic surgical skills on computerized simulators, mannequins and dead animal tissue. Although they watch surgeons work on human patients and may pass instruments or snip sutures, they're not allowed to operate on people.
Freischlag said pigs give students the feel of live tissue - and help students decide whether they really have the interest or dexterity to become surgeons.
"Simulators have no feedback as to texture and touch," Freischlag said. "That's where it's so important to use animals, to feel all the right tensions and strengths."
Freischlag argued that most schools have abandoned pigs because of their high cost. She said that the Hopkins live-animal program had "dwindled" by the time she came to Hopkins five years ago but that she reinvigorated it at a cost of $75,000 per year because students demanded it.
During their third or fourth year, students spend two days in a pig laboratory learning to control bleeding, remove organs, and detach and reconnect segments of bowel. The pigs are anesthetized at the beginning of each day and euthanized at the end, officials said.
Officials said teams of students are assigned to each pig to minimize the number used, but they would not provide precise figures.
A local vendor supplies the pigs and delivers them to the laboratory the day they are used. Dr. Chris Newcomer, vice provost for animal research, said four veterinarians attend each lab to ensure the animals are properly anesthetized and handled.
He disputed claims by animal rights activists that pigs are prone to waking during surgery, an occurrence that would expose them to pain. "That's more reminiscent of what would have happened 30 years ago," he said, claiming that anesthesia techniques have "jumped way ahead."
Yesterday, a half-dozen doctors with the Physicians Committee for Responsible Medicine handed out fliers at the hospital's main entrance on North Wolfe Street. A banner urged medical students to "blow the whistle on cruelty."
Pippin said the physicians' group started peppering Hopkins officials with e-mails, letters and phone calls two years ago. Freischlag, the course instructor and Dr. Edward D. Miller, the school's dean, were among those targeted.
In its editorial, the Hopkins newspaper urged the medical school to extend to animals the same "do no harm" principle taught to medical students over the ages.
In the 1980s, medical schools across the country phased out the use of live dogs in surgical laboratories and shifted to pigs, which were not only anatomically closer to humans but were also less likely to arouse passions than dogs.
But since then, protesters have taken up the barnyard animal's cause. The Physicians Committee for Responsible Medicine, which also promotes vegetarianism and opposes the consumption of dairy products, has pressured numerous schools in recent years.
Twelve schools have quit the live-pig practice since 2006, according to Pippin. Case Western will be the 13th, but spokeswoman Laura Massey denied that the Cleveland medical school had buckled under pressure. "We want to make it very clear this had nothing to do with the PCRM," she said.
The University of Maryland School of Medicine relies completely on simulators and virtual reality techniques. In a suite of operating rooms stocked with these devices, students practice such techniques as removing gall bladders and inserting breathing tubes.
Many of the devices train students in laparoscopic techniques, in which surgeons view their work on video screens. Operating on live animals might give students a better feel for the textures and tensions of living tissue, but officials say that experience can be left for surgical residencies. "Medical school is not about technical skills - it's about cognitive abilities," said Dr. Bruce Jarrell, vice dean for research and academic affairs.
Gerald Moses, who heads the simulation lab, added: "Sparing animals discomfort elevates the whole paradigm of learning."