Trump Or No, Science Badly Needs To Look Inward And Heal Itself

On “Doctored” By Charles Piller

I’m really annoyed, on behalf of the journalist Charles Piller, about the release date of his book Doctored: Fraud, Arrogance, and Tragedy in the Quest to Cure Alzheimer’s, which anyone who enjoys this newsletter should read.

In his book, Piller, an investigative reporter at Science magazine, presents copious evidence of severe fraud, negligence, and buck-passing in Alzheimer’s research. From fabricated images published in major research journals (many of them still unretracted) to data manipulation conducted by pharmaceutical companies to the complete negligence of federal watchdogs, Piller’s reporting demonstrates indisputably that the field of Alzheimer’s research is in sorry shape.

Things are so bad, in fact, that the dominant theory that has guided researchers’ efforts this century — that Alzheimer’s symptoms are caused by the buildup of proteins called “amyloid plaques” in the brain — is now in serious question. That might explain why, as Piller notes, a recent meta-analysis of the available research found no evidence that any of the available Alzheimer’s drugs cause noticeable improvements in the cognition or daily functioning of patients. We’re two decades and many billions of dollars into the modern era of Alzheimer’s research, and we have precious little to show for it — a particularly dire state of affairs given that this dread condition is only going to hit us harder as America’s population continues to age. Piller’s book, which was released February 4, tells the story of a wild and heartbreaking goose-chase.

While Doctored is gripping in its own right, it also serves as a warning about the collapse of trust in expert authority. Thanks to the capacious new markets for crankery carved out by social and “alternative” media — not to mention a worldwide populist revolt against “the establishment” in general — there’s more grifting and science-denial than ever before, and the worst purveyors of pseudoscientific sludge rake in millions precisely by positioning themselves in opposition to mainstream science.

This gets to why the book’s release date proved inconvenient. Donald Trump won a second term as president in part because of a belief that the establishment needs to be torn down, and he seems intent on doing just that when it comes to science. When I first started this post, which was prior to his inauguration, I was going to cite, as examples, choices like his nominees for head of Health and Human Services (anti-vaccine crank RFK Jr.) and the Environmental Protection Agency (Lee Zeldin, an ardent opponent of meaningful attempts to fight climate change who has been confirmed).

Obviously things have gotten far worse since then: Trump and his chief lieutenant, Elon Musk, are attempting to take a swift, careless, and (at least partially) illegal and/or unconstitutional hatchet to the federal budget, and in part for political reasons, federal research funding is very likely to be on the chopping block. In his first days in office, Trump signed an executive order which froze the disbursement of National Science Foundation funds. This had an immediately disastrous impact on the lives and careers of the many researchers who rely on NSF every day — not to mention their projects — though the freeze was later undone by a court order.

At a time of such uncertainty and such dangerous overcorrection, it can feel awkward or difficult to point out, as Piller does in Doctored, just how broken some of our cherished mainstream scientific institutions are. Isn’t that playing right into Trump’s hands?

I don’t think so. The strategy adopted by many mainstream liberals in response to the populist surge — effectively, plugging our ears and chanting “trust the science” over and over — might be comforting, in that it offers a Manichaean worldview in which improving the world is a relatively straightforward matter of convincing people of their own ignorance so that they will board the science train with the rest of us.

But this effort has clearly failed. Some populist distrust of mainstream science is unwarranted and harmful, such as most strains of vaccine skepticism, but in plenty of instances, they are more or less correct not to automatically trust mainstream scientists, even if they arrive at that conclusion for reasons some of us might find uncouth. (Update: I added ‘automatically’ post-publication because I think it’s an important modifier here.)

In other words, while it’s easy to accuse those red-staters out there of exhibiting an alarming lack of faith in science, especially now that their wrecking-ball avatar is in power, it’s harder — and arguably just as important — to ask whether perhaps we have too much faith in it. The scientific establishment hasn’t exactly covered itself in glory in recent decades, given the replication crises that have roiled multiple fields, the data-fraud scandals popping up everywhere from cancer research to business-school psychology, and the frequently overconfident proclamations experts made about thorny Covid-era issues like mask mandates and school closures. And yet liberals tend to continue to reflexively trust many institutions that haven’t earned it, to the point where some of us have turned this sentiment into a mantra: “Science is real,” you will see on signs planted in front of many liberal homes.

In an abstract sense, sure, science is “real”: Done properly, it can bring us miraculous advances. And good, sound, productive science often proceeds unbothered behind the scenes, producing innovations in medicine or consumer products or whatever else only many years later. But you know what’s also real? Human frailty, which chronically hinders the execution of sound science. To ignore this is to let powerful people and institutions off the hook, all while providing more fuel for the burn-it-down crowd.

Piller’s book provides numerous damning examples of the difference between science as we idealize it and science as it is practiced by real-life human beings. For example, much of the data fraud in Alzheimer’s research, alleged and proven, involves doctored images. This fraud was uncovered not by journal editors or peer-reviewers — the individuals supposedly responsible for such quality-control — but by unpaid sleuths “who use pseudonyms to post comments” online, as he writes, in the hopes of someone who matters noticing and acting. (One notable exception is Elisabeth Bik, a Dutch microbiologist and legendary image sleuth who has taken on Alzheimer’s fraud.)

All too often, though, no one did: According to Piller’s reporting, journals have frequently slow-walked subsequent investigations and have proven quite reluctant to retract papers that seem to plainly warrant it, while universities have frequently closed ranks around researchers credibly suspected of fraud rather than engage in prompt and thorough investigations. Anyone who reads this newsletter knows that in my own reporting on youth gender medicine, I’ve found journals and individual researchers are not only loath to correct or explain errors, but often unwilling to even respond to basic questions about their work.

That’s the problem with demanding that people “trust” science just because it calls itself science, or just because it’s being conducted by an institution or an individual toting impressive-seeming credentials. More deference is not the answer, because undue deference lies at the root of almost every major scandal in science. Why should you trust a journal that refuses to correct its errors, or a university that protects a star researcher credibly accused of fraud? And at the risk of repeating myself: While these stories are particularly galling when you read about them in Doctored given just how much human anguish is at stake, they are by no means unique to Alzheimer’s research.

It’s no surprise, in light of the book he just wrote, that Piller believes that science is in something of a crisis: “The institutional authorities of science — journals, universities, funders, and regulators — face a pivotal moment,” he said in an email. “They need to get serious, fast, about policing fraud and fakery in scholarly papers, medical research, and grant proposals. If they don’t, the ‘tear-it-down’ anti-science forces in the Trump administration and beyond could do lasting damage to essential research we all depend on.” He sent me that note before Trump started to, well, tear it down, and it proved depressingly prescient.

I don’t have confident answers here other than yes, definitely read Doctored if you want to better understand how science goes wrong. Based on the hasty and careless way they’re operating, the probability that Donald Trump and Elon Musk or their subordinates are going to do more harm than good is extremely high. But the current political situation isn’t forever; in the future, our scientific institutions (or what is left of them) will still have to prove they’re worthy of our trust. And they have a long way to go.

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Questions? Comments? Cures for Alzheimer’s? I’m at singalminded@gmail.com, on Twitter at @jessesingal, or on Bluesky at @jessesingal.com. Image via ChatGPT.