I bought this product for a gentleman in Peru who suffers from enlarged prostrate and painful and frequent urinary issues. He's been on it for a month now and experienced relief so that part is very positive. So the effectiveness of the product deserves the very good rating. However, at a monthly income of $370, this is very costly being nearly 20% of what he lives on in a month. These kinds of products simply need to be more affordable for the people who desperately need relief but cannot eonomically compete with spendy American price points. Therefore I put cost at very poor because a good product is out of range for people who could really benefit. Thus the 3 star ratign being an average of the two variables