Formulation governs the lived experience. Texture, scent, packaging, and regimen simplicity shape its daily use. This lever determines whether a product is enjoyed, tolerated, or abandoned. Even the most efficacious, evidence-based products may fail when their formulations make consistent use difficult. For example, a moisturizer that is supported by strong evidence may still fail in the hands of the consumer if it leaves a greasy residue. While the other domains are foundational to the product, without appropriate formulation, even a great concept will fail in real-world use.²

Evidence signals credibility. Clinical studies, efficacious ingredients, and mechanistic clarity establish trust in both experts in the field and consumers. To be effective, evidence must be understandable and transparent. Complex, nuanced data must be translated into digestible messages for broad audiences. Additionally, there are red lines that must not be crossed when it comes to making drug-like claims for over-the-counter products, as well as practical limitations given the relatively small budgets compared to pharmaceutical development. Panditrao argues that the mere over-the-counter availability of a product implicitly signals an inherent safety to the consumer.³ As such, evidence alone does not guarantee success but is necessary to support real-world effectiveness. For example, well-studied ingredients in an over-the-counter hair regrowth solution are more likely to be backed by clinicians and trusted by consumers.⁴

In line with Rogers’ diffusion of innovations perspective, evidence most closely aligns with the concept of relative advantage, which signals product superiority over current alternatives. Rogers argues that innovations with a clear relative advantage are adopted more rapidly.¹ In the context of health care products, clinical evidence is one of the most influential ways to communicate this advantage, as it provides credibility of efficacy and safety.

Narrative shapes perception before the product is ever used, through brand story, social proof, and community values. An over-the-counter acne treatment may be perceived differently depending on presentation, whether marketed as a clinically inspired product or a beauty trend. Social media influencers and online discourse operate this lever, accelerating trust and familiarity, though not necessarily substituting for evidence or education. Consumers often rely on cues and emotional trust from peers, influencers, and online communities when considering unfamiliar products.² One study of 130 patients with acne, for example, demonstrated that nearly half of the patients had consulted social media for treatment guidance, with many making changes that did not align with clinical recommendations.^2,5 Narrative plays a powerful role and often precedes evidence in real-world decision-making.

Rogers’ concept of compatibility, which reflects how quickly an innovation is adopted when it aligns with consumers’ values and experiences, offers insight into this mountain. A supplement endorsed on social media or a sunscreen that integrates naturally into an established skincare routine is not only better marketed but is also, according to Rogers’ framework, more likely to be adopted. Narrative is the main pathway through which compatibility is established before the product even reaches the consumer’s hands.

Accessibility determines whether the product can be obtained and therefore used, converting interest into action. Distribution channels, pricing, and ease of purchase define this lever. Without this, the product effectively does not exist. Even a well-formulated and trusted barrier repair cream cannot thrive if it is difficult to find or expensive.⁴ Pricing operates both as a barrier to entry and a value signal, influencing not only purchase decisions but also long-term satisfaction and use.⁶ Strategic distribution, whether through retail or clinical settings, determines not only who can find the product but also who chooses to purchase it.⁷ Accessibility is central to understanding how products reach consumers, because a product that cannot be accessed cannot succeed.

Education guides consumers toward confident, effective product use. Ingredient literacy, regimen guidance, and transparent communication reduce confusion by helping consumers use products correctly. Education succeeds when it lowers cognitive load rather than maximizing engagement. Therefore, this lever is essential in building confidence and reinforcing adherence and trust across the other domains. For example, clear instructions explaining why, how, and when to apply a retinoid cream can determine whether this product is used or left behind. Content creation, including patient-facing videos, infographics, and social posts, extends educational reach beyond the clinic and into the spaces where consumers already seek information. For the clinician-founder, content creation represents an opportunity to translate clinical expertise into accessible formats, bridging the gap between professional knowledge and consumer understanding.

Clinician education, while overlapping to some degree, also differs from that of consumers. A fuller discussion of clinician educational opportunities includes the conventional “three P’s”: Posters, Podium (ie, scholarly lectures), and Publications, along with the more modern additions of Podcasts, Play (eg, gamification and smartphone apps), Peer-to-peer learning (eg, social media), and even Patient Interactions like simulations and patient feedback.⁸ A more recent addition is an eighth “P”: Prompting, which reflects the use of large language models (artificial intelligence tools) to query diseases, treatment strategies, and products.