From illegal prescription drug imports to irresponsible ordering of contact lenses, it appears of late that the standards of safety in patient care that have historically characterized this country's health-care system are unraveling. The role of a "learned intermediary," an educated liaison, such as a family practitioner or ophthalmologist, between the manufacturers of drugs and the individuals using them has been a cornerstone of this system. There is a reason the learned intermediary is put in this place; there is a need to be met, and the medical professionals occupying this role meet the need to provide patients the best care possible by adhering to legal, moral and professional obligations. The training and actions of such medical and eye-care practitioners are intended to provide patients protection and unbiased consultation. This is true whether speaking of prescribing drugs or of contact lenses.

Prescription drug importation from Canada by consumers is not a new practice, but has recently gained the spotlight. Entire towns, such as Springfield, Mass., are defying Food and Drug Administration regulations and importing Canadian drugs for city employees and retirees. However, these drugs, particularly Internet purchases, can pose significant health and safety risks, as they have not been FDA-tested for safety and efficacy and are unlikely to measure up to these strict standards and those for manufacturing. Of additional note is the improper handling of imported drugs. Recently an insulin shipment from a Canadian supplier was documented as being shipped in non-refrigerated conditions, resulting in the distinct possibility of compromising the safety and efficacy of using this drug. The foundation of this country's high standards lies in the FDA-regulated approval, manufacturing and distribution of drugs, standards to which imports do not adhere. Such disregard puts the health of patients at great risk.

An analogous situation is that of contact lens prescriptions and the use of third-party contact lens manufacturers that utilize 1-800 numbers and Internet ordering of contact lenses to circumvent the learned intermediary. There is nothing to be gained from eliminating the vital role of an educated medical professional from the process of dispensing drugs or medical devices such as contact lenses. In fact, product liability presupposes the presence of such a learned intermediary; with no one in this role, patients' capacity to hurt themselves skyrockets and becomes the responsibility of the health-care industry.

These occurrences only allow for further straying from the tightly woven standards of practice and patient care that are intended to maintain the integrity and safety of American health care. It is the same for drugs or lenses: The learned intermediary, the cornerstone of the system, should not be allowed to disintegrate or fade away. Those who stand up for the enforcement of the use of proper channels for drug or device prescription use should be applauded for their efforts to both maintain the integrity of the system and eliminate those means by which, to the detriment of all, this system is being broken down.

Dr. Abelson, editor of our Therapeutic Topics column, is an associate clinical professor of ophthalmology at Harvard Medical School and senior clinical scientist at Schepens Eye Research Institute and consults in ophthalmic pharmaceuticals.