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you probably almost never use the pills because you don't want to roll the 50% chance it'll hurt you - and if you're ever thinking of that you're already down at least one life.
On a 2 life round that'll kill you. (from 1)
On a 3 life round that can potentially doom your run since if you're thinking of using medicine you likely cannot prevent the dealer from getting another chance to shoot you. (From 2)
On a 4 life round, if you have 3 lives left, you MIGHT gamble on it. Maybe. Most likely you're just popping it to clear space for items in the holdover round.
All of this means you almost never use the pills, and then humans naturally remember the negative experiences stronger than the positive ones.
pills just kind of suck, and that's honestly okay since you can use them as bait for dealer's adrenaline rather than him stealing your info items or whatever.
Also I don't want them to be buffed because watching Dealer drop like a rock is hilarious.
I'm probably also of the belief most of these accusations is some form of confirmation bias, where the Dealer must be cheating because he wins sometimes. Most times it can be in your favor if you know what you're doing and acknowledge the other times are inevitably not.
1. There's no way I'm getting lucky and surviving without them.
or
2. I have 2 health but the dealer has a handsaw and 1 less health won't make me any worse off than I already am.
or
3. There's no way I can take any more damage before the next load, I have exactly 2 health and a maximum of 4.
Last resort... as said earlier its just used when clearing space for items