title: What is wrong with 'being a pill-taker'? The special case of statins.
abstract: 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.
authors.affiliation: Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Louisa
authors.initials: L
authors.lastname: Polak
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D050171:Dyslipidemias / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D007407:Interviews as Topic; D008297:Male; D062528:Medicalization; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010465:Perception
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: adherence; cardiovascular disease; healthism; identity; medicalisation; surveillance medicine