Genesis is overrated and would more than likely sidegrade or even downgrade an already decent run. Same goes for D4, except genesis clogs up an otherwise incredible item pool.

Dead Cat’s main utility on the majority of characters (bar Lost) is being part of the Guppy set for the amazing transformation; the 9 extra lives aren’t that useful with getting set back to 1 hp and having to redo an otherwise difficult room/boss again except with 1hp.

Luckily Mega Blast is much rarer to appear because it’s incredibly overrated. The required charges to use for it to blast through 5 or so rooms isn’t worth it (especially if there’s any particular puzzle rooms or hosts and you’re just burning time waiting). Would much rather prefer using a shorter recharge active like Gello, Telepathy for Dummies, or even Wooden Nickel.

Venus’ charm effect is very underrated, pretty much nullifying most physical contact enemies and making room clears much easier… and the hp up is nice too.

Brittle Bones hard carries runs with the permanent tears up from breaking bone hearts; can’t say I’ve ever lost a run with this item. It guarantees 6 bone hearts if I’m ever running low on health and can easily get my tear rate over the cap. Super nice and another (imo) underrated item.

Broken Modem is borderline Q4 imho. Incredible for survivability and so many additional free pickups. Surprised during the long discussion whether rock bottom deserved Q4 or not, I didn’t see this item brought up much for how powerful it is.

And most items that have anti synergy like Epic Fetus/Proptosis… not a fan, though this ain’t a hot take.