In an interview study of decision‐making about statins, many participants said they took pills regularly, yet described themselves as ‘not really pill‐takers’. This paper explores this paradox and its implications. The practice of pill‐taking itself can constitute a challenge to the presentation of moral adequacy, beyond the potential for rendering stigmatised illnesses visible. Meeting this challenge involves a complex process of calibrating often‐conflicting moral imperatives: to be concerned, but not too concerned, over one's health; to be informed, but not over‐informed; and deferential but not over‐deferential to medical expertise. This calibration reflects a broader tension between rival tropes: embracing medical progress and resisting medicalisation. Participants who take statins present them as unquestionably necessary; ‘needing’ pills, as opposed to choosing to take them, serves as a defence against the devalued identity of being a pill‐taker. However, needing to take statins offers an additional threat to identity, because taking statins is widely perceived to be an alternative strategy to ‘choosing a healthy lifestyle’. This perception underpins a responsibilising health promotion discourse that shapes and complicates the work participants do to avoid presenting themselves as ‘pill‐takers’. The salience of this discourse should be acknowledged where discussions of medicalisation use statins as an example.