The death of one woman and a highly publicised liver transplant operation of a television personality have put the multi-million dollar slimming industry under scrutiny in this tiny island republic, where "slim is beautiful" has been a mantra.

The 'Slim 10' saga, as it is known here, has raised questions both in Singapore and across the border in Malaysia about the value of "beauty" over health, business ethics and medical practices.

Selvarani Raja, a 43-year-old logistics executive, died last month of liver failure, while Andrea De Cruze, a 27-year-old television presenter, had to undergo a liver transplant to save her life. Both were known to have taken the Chinese herbal remedy 'Slim 10' pills.

Sixteen other Singaporean women who have taken the pill are believed to be suffering from hyperthyroidism and liver failure.

After the huge publicity generated by these two cases both here and in Malaysia, government authorities have moved to regulate the slimming industry — especially over-the-counter pills being offered by pharmacies.

The Slim 10, a "herbal" remedy imported from China, was found to contain fenfluramine — a chemical which is prohibited in the United States and many other countries, including Singapore.

20,000 bottles sold

Since its launch in late November until its withdrawal from the market in April, about 20,000 bottles of Slim 10, each containing 120 pills, have been sold in Singapore at 150 Singapore dollars (84 US dollars) per bottle.

The pills were adulterated after they passed testing and cleared for sale in Singapore, health authorities say, adding that they are now testing 45 other Chinese slimming products in the market to ensure these have not been adulterated.

The sad story has also raised many doubts about Chinese traditional medicine, which is very popular in this city state, 70 percent of whose people are ethnic Chinese. The cases have raised doubts on China's control — and ethics — over its traditional health care products.

"As part of our ongoing review and from our analysis of the Slim 10 adulteration, we are reviewing the labelling requirements for Chinese proprietary medicine products, regulation of slimming products and accreditation of laboratories which conduct testing," says Dr Clarence Tan, chief executive officer of the Health Sciences Authority (HSA).

Meanwhile, the Chinese Physicians and Medicine Dealers Association of Malaysia has warned the public against slimming pills that promise speedy results.

Traditional medicine

"Slim 10 is said to be a traditional medicine, but it contains fenfluramine, a western drug associated with heart-valve and thyroid problems and hepatitis," observes Thong Choong Khat, general-secretary of the association.

"In Malaysia, this is illegal because it is government policy that traditional medicines should not contain ingredients of western drugs".

In Singapore, the HSA has filed charges last week against the importer of the Slim 10 pills. The company, Health Biz Pte Ltd and its director, Semon Liu, faces eight charges of contravening the Poisons Act. The charges carry a maximum penalty of 10,000 Singapore dollars (5,600 US dollars) fine and a jail term of two years for each of the charges.

While the debate is very much focused on medical and business ethics, there is little public debate on the value system here, which sometimes forces young and not-so-young women to buy expensive slimming products.

Speaking on local television, recruitment consultant Ruby Chen said that for frontline jobs in Singapore, one rarely recruits someone who is overweight. "No human resources person would write it in policy, but in an interview, fifty percent of the decision is made on appearance alone".

Rene Yap, an 18-year-old polytechnic student, admits that she had been under pressure to take slimming tablets. "I was tempted to try Slim 10," she says. "But eventually I didn't because I wasn't comfortable with the high dosage of the pills and they're quite expensive. I guess not being able to afford it saved me."

Big business

Since the dieting industry is big business here, Yap argues that it isself-esteem that helps to fight peer pressure. "I don't think I'm ugly because I'm fat, but rather, I can look better if I'm thinner."

"Subconsciously, women feel the need to appeal to men for relationships be it in the courtship stage or maintenance of a relationship like marriage or even affairs," says Clare Lee, a single advertising executive in her 30s.

Surfing through the forum page of a well-known website here called "samyboy", one cannot but agree with Lee. This forum is popular with men chatting about women and relationships, and talk of a woman's slim figure is among their favourite topics.

Dana Teo-Lam, an activist and writer, argues that women are more vulnerable to taking slimming pills not only because of modern cultural trends, but also because of vulnerability to depression.

She points out that there are twice as many women than men in Singapore who suffer from depression. And because women tend to resort to pills, she says, there must be tighter accountability on the part of the pharmaceutical industry.

"People trust pharmacies to know what they are selling. Raja died from the trust in the system to filter out risks for her," she notes. "I really think we should be putting pressure on pharmacies to re-examine their conscience and rethink what they put on their shelves."

Some might even suggest that people re-examine their image of themselves and rethink what they pop into their mouths.