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Ebook reading devices are indeed a different market from computer-readable files. PDFs formatted for reading on a computer screen are usually awful on mobile devices (which range from the 10" iLiad down to 3" PDAs, and there are a lot of people who want their files to be shift-able from computer to whatever device they happen to use.
The hard part for publishers to deal with, is that each person wants the file optimized for his or her device--and they're all different.
<i>additional concern is that the work could be altered and then distributed in an altered form by someone who doesn't like what the book says</i>
Don't worry about this. It doesn't happen.
Okay, it could happen. It probably does, in some tiny corner of the internet. However, the few attempts to do anything like it generally just result in better publicity for the original; changed imitations don't have the same authenticity as the original, and it's usually obvious even to casual readers. Anyone who wanted to put enough effort into it to fool most readers, could just buy the print book, scan it, OCR the scans, and change whatever they liked. Ebook security won't affect the ability of a dedicated rival to produce realistic-but-flawed imitations.
I believe no portable ebook devices read .exe files. (Which I believe are mostly bundles of HTML files with enough code to make them run when clicked on. I have no idea what kind of security they have, or can have.)
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