How to get D6 as basic item for Isaac

As mentioned here by Ed, some effects are no heart drops from bosses and curses being more prevalent.

I'd hazard to guess that less drops in general and higher HP enemies might play a part. Especially less drops.

And here's his general notes copied over from the linked post:

• Beating different goals in Hard mode will unlock new content not unlockable on Normal.
• Beating said goals in Hard mode will also unlock any unlocks that would be gained by beating Normal mode (so you can start on hard if you’d like)
• There will be achievements for Hard mode.
• Hard mode will have some visual hud/menu changes so you are always aware if you are playing on Hard. (or watching someone play on Hard)

Lazarus starts with different items than Isaac does. Notably, he starts with an item that gives him an extra life (hence the name Lazarus).

He also seems to start with a random pill... but unlike Isaac, Lazarus doesn't start with any Bombs.

Edit: I haven't gotten far enough to check this, but in the original game, Isaac would start with The Dice if you'd unlocked them... Lazarus likely doesn't.