Doctored narratives \ Fraud, trust, and the ethics of exposing misconduct

How can we balance the exposure of misconduct with the preservation of public trust? It’s not a new question, but it’s one I’ve been reflecting on more intensely in recent months as a controversy erupted in a field I’ve followed for years: Alzheimer’s research. The spark was Doctored: Fraud, Arrogance, and Tragedy in the Quest to Cure Alzheimer’s, a book published earlier this year by investigative journalist Charles Piller.

I first got pulled into the debate after seeing someone on social media post their blunt takeaway: “The Alzheimer’s field is in a total mess.” I pushed back, and in doing so found myself drawn deeper into the discussion. I checked in with Alzheimer’s researchers I know personally, including my former PhD supervisor, and followed the conversation on Alzforum, a key online hub for the field.

What I found as I read further through public statements, internal emails between researchers, and correspondence with journal editors, exposed deep fault lines—between journalism and science, between accountability and sensationalism, and between transparency and public confidence.

THE CASE

Drawing on years of investigative reporting, Piller’s Doctored claims to reveal a widespread pattern of fraud, negligence, and regulatory failure that he argues has misdirected decades of Alzheimer’s research. Central to the book is the high-profile case of Sylvain Lesné, a University of Minnesota researcher accused of manipulating data in a landmark 2006 Nature paper on a toxic form of amyloid beta (Aβ56). According to Piller, this fraudulent work reinforced the so-called amyloid hypothesis, contributing to the misallocation of billions in research funding and the development of ineffective drugs.

He connects this case to a broader pattern of questionable research practices, painting a picture of a network of scientists, pharmaceutical companies, and regulatory agencies, described in the book as a “cabal”, that has perpetuated this flawed scientific agenda, prioritizing prestige and profit over patient welfare. The book, promoted as a hard-hitting exposé, has received favorable reviews in the popular press for its investigative scope and narrative drive.

Yet this framing quickly ran into resistance from within the Alzheimer’s research community, where many viewed the book as a dramatic overreach.

THE BACKLASH

Importantly, the researchers I heard or read comments from do not dispute the existence of fraud in isolated cases. The concern, they argue, lies in how the book extrapolates from these cases to indict an entire field.

“As a named member of this cabal, I reject this characterization,” wrote geneticist John Hardy in a review initially commissioned—and later declined—by Nature. Hardy acknowledges that misconduct, including the Lesné case, must be condemned. But he disputes Piller’s claim that this episode fundamentally shaped the trajectory of Alzheimer’s research. “This work was never replicated and... quietly died. Now [the authors] are being publicly murdered. I am not sure which is the better way,” Hardy reflected, highlighting an uncomfortable tension between the scientific community’s traditional, self-correcting mechanisms and today’s climate of public shaming.

Belgian researcher Bart De Strooper expressed similar concerns, not just about the book but about the role of Science magazine in giving Piller a platform. “Why does the journal Science lend its considerable prestige and authority to anti-science journalist Charles Piller?” De Strooper asked publicly, sharing email exchanges in which he challenged Science’s editorial leadership. He argues that Piller exploits his affiliation with a leading scientific publication to give undue weight to his claims, blurring the lines between investigative journalism and peer-reviewed science.

Clinical researchers have voiced alarm over the potential impact on patients. “One of my patients who plans to take one of these anti-amyloid drugs explained that the scandals reported by Piller made him question his decision,” noted Jason Karlawish of the University of Pennsylvania. He described similar reports from colleagues of study participants dropping out of clinical trials. “Trust is like porcelain: a beautiful thing, easily cracked. Once cracked, hard to repair.”

Donna Wilcock of Indiana University, who had engaged with Piller during his research, emphasized that while misconduct must be addressed, the book misrepresents the field’s broader progress. “The science for a significant role for amyloid in Alzheimer’s disease is robust and stems from numerous laboratories worldwide,” she wrote. “The clinical trials of the two approved anti-amyloid immunotherapies are strong in showing some slowing of cognitive decline when amyloid is lowered substantially.”

Indeed, many experts point to the recent FDA approvals of lecanemab and donanemab (two drugs targeting amyloid) as evidence that the amyloid hypothesis, while not the whole story, remains a scientifically valid pathway. Eric Reiman, director of the Arizona Alzheimer’s Consortium, warned that the book’s sweeping claims risk overshadowing these advances. “Mr. Piller grossly overstates the falsified data’s impact on the study, treatment, and potential prevention of Alzheimer’s disease,” he wrote.

These concerns were echoed in a Viewpoint article published in JAMA by Joshua Grill and Gil Rabinovici from the University of California. Fraud must be exposed, they argue, but Piller’s framing risks undermining trust in the broader field. They warn that the book’s sweeping claims could harm public confidence in emerging Alzheimer’s treatments just as the first disease-modifying drugs have gained regulatory approval.

DOES FRAUD EXPOSURE EQUAL TRUST EROSION?

Critics of the field argue that the dominance of the amyloid hypothesis has, in fact, stifled alternative approaches. Some point out that the culture of “going along to get along” in science, driven by funding, reputation, and institutional loyalty, may have discouraged critical scrutiny of high-profile work. 

“It was the dominance of the amyloid hypothesis that created the intellectual environment where reports of new data supporting it were less likely to be questioned,” noted Karl Herrup of the University of Pittsburgh, adding that the field must guard against intellectual conformity.

This tension between exposing flaws and preserving credibility lies at the heart of the Doctored controversy. Science needs watchdogs to call out misconduct, but what happens when watchdogs themselves are accused of overstating their case? Journalism’s power lies in its ability to bring issues to public attention, but this power carries responsibility. Overgeneralization, selective sourcing, and rhetorical framing can turn legitimate criticism into misleading narratives with real-world consequences.

Adding to the complexity is the role of scientific journals like Science and Nature, which publish both peer-reviewed research and journalistic investigations. The independence of these editorial functions is essential, yet the shared branding can blur boundaries for the public. Readers may not distinguish between a news story and a peer-reviewed article, lending unintended authority to journalistic claims.

Moreover, the media ecosystem tends to reward sensationalism. As Science’s editorial leadership acknowledged in internal correspondence, “Charlie [Piller]’s book is likely to be a big seller. My advice to the amyloid community would be to figure out a proactive story rather than attacking journalists, which has never worked very well.” 

WHERE DO WE GO FROM HERE?

For science communicators, the Doctored debate is a timely case study in the ethics of narrative framing. Both sides of this controversy raise valid points: fraud must be exposed, but narratives that cast entire fields as broken risk eroding public trust in science as a whole. There are no easy answers.

And yes, the irony is not lost on me that by writing this article for Big Bang magazine, I am once again giving oxygen to a book I’m not sure deserves more attention. But ignoring it isn’t an option either. These debates shape public understanding, research priorities, and patient decisions. We owe it to ourselves and to the public not to leave the conversation to the loudest voices alone.

As science communicators, we are left with hard questions. How do we balance the responsibility to expose wrongdoing with the risk of undermining public confidence? How can journalism and science collaborate without compromising their distinct responsibilities? And perhaps most importantly, how do we foster constructive public dialogue—one that informs, rather than inflames—in a world where trust in science feels increasingly fragile?