Discussion: The nature of what Cure Disease can cure

[Stealth Marmot]

I was considering the question and I feel it might be worth discussing, what precisely could a theoretical Cure Disease spell actually cure?

Beyond that, what could not be cured by Cure Disease that might be cured by even more advances magic like Heal or Regeneration?

For example, would Cure Disease cure Osteoporosis? Diabetes? Would it cure Lupus or Multiple Sclerosis? What about mental afflictions like Schizophrenia, Dementia, or even Chronic Depression?

[theasl]

Not sure how RAW/canon this is, but in Temple of Elemental Evil (the crpg version, at least), you can use Heal to cure a guy with dementia.

[ExLibrisMortis]

That depends entirely on how you map real-world disease to D&D mechanics. D&D diseases are typically (not always) contagious, so I wouldn't model osteoporosis, diabetes, dementia or depression as a disease in D&D (without making any further claims on whether and how much they are diseases in real life, and how far you can usefully stretch the word 'disease').

[dervin]

In one of the games i was in a important NPC could not get his cancer cure with cure disease. I think that was a house rule.

[Segev]

Theoretically? It should cure anything that isn't a magical curse or outright physical injury. It won't cure an amputated limb, but it will cure the gangrene that might otherwise have required amputation. It won't cure blindness, but it will cure the diabetes that's making you go blind. AIDS, cancer, any number of auto-immune disorders, the common cold, multiple sclerosis, muscular dystrophy, cerebral palsy, Parkinson's... it'd be a game-changer in terms of modern medicine.

It won't cure "diseases" that are really curses. So if somebody hits you with a bestow curse to have cancer, then the cure disease might, at best, cure that instance of cancer, but you'll contract a new one right away thanks to the curse. I don't think it'll touch mummy rot (which is explicitly a curse), but it will cure ghoul fever (which is explicitly a disease).

[Flickerdart]

Well, let's read the RAW.




Remove disease cures all diseases that the subject is suffering from. The spell also kills parasites, including green slime and others. Certain special diseases may not be countered by this spell or may be countered only by a caster of a certain level or higher.



All this tells us is that the spell cures all diseases and parasites, unless the disease is "special." Typically that means the disease's description says so.

However in D&D, disease is a rules term, and all diseases (http://www.d20srd.org/srd/specialAbilities.htm#disease) are infectious. We can thus rule that remove disease only affects infectious diseases.

[Segev]

However in D&D, disease is a rules term, and all diseases (http://www.d20srd.org/srd/specialAbilities.htm#disease) are infectious. We can thus rule that remove disease only affects infectious diseases.

While not a bad rule of thumb if you choose to use it, this is not a logically sound argument. Just because all examples of blackbirds we see are crows does not mean that only crows are blackbirds.

[Deophaun]

There is a question as to whether aging is a disease. Immortality for 3 gp a year (1 remove disease every 50 years) sounds about right.

[DontEvenAsk]

While not a bad rule of thumb if you choose to use it, this is not a logically sound argument. Just because all examples of blackbirds we see are crows does not mean that only crows are blackbirds.

When the rules text specifically says that "diseases" (game term) are spread (in a variety of ways, at that) as part of the definition of the rules term, I think it is safe to say that "diseases" are spread/communicable, and therefore that diseases (real-world term) that are not communicable do not count as "diseases."

[Segev]

When the rules text specifically says that "diseases" (game term) are spread (in a variety of ways, at that) as part of the definition of the rules term, I think it is safe to say that "diseases" are spread/communicable, and therefore that diseases (real-world term) that are not communicable do not count as "diseases."

"Spread in a variety of ways" doesn't exactly preclude "by inheritance" as one of those "variet of ways."

Essentially, that phrase is meaningless as a rules term. Unless literally nobody can ever contract the disease in any way, it has somehow spread in some way to that person.



There is a question as to whether aging is a disease. Immortality for 3 gp a year (1 [i]remove disease every 50 years) sounds about right.
Even by the most modern of understandings, terming aging a "disease" in and of itself is stretching it enormously, and it certainly is reaching well beyond the bounds of what a D&D setting is going to consider one. Now, maybe for a race that is considered naturally immortal, that might be a symptom of a disease, but aging itself? You're going to have a hard time making that case.


By modern understanding, even, aging (past your prime) is a simple degredation of the body's ability to regenerate from damage. Cells don't replicate well enough to keep up, and so you slowly start losing ground against damage and disease. This is why those who live to appear "old" get frail; they just aren't maintaining their robust regeneration against the ravages of the world.

[Caelestion]

Even if non-contagious diseases are 'just' nasty permanent conditions, a heal spell would clear those all up.

[Starbuck_II]

Even by the most modern of understandings, terming aging a "disease" in and of itself is stretching it enormously, and it certainly is reaching well beyond the bounds of what a D&D setting is going to consider one. Now, maybe for a race that is considered naturally immortal, that might be a symptom of a disease, but aging itself? You're going to have a hard time making that case.


By modern understanding, even, aging (past your prime) is a simple degredation of the body's ability to regenerate from damage. Cells don't replicate well enough to keep up, and so you slowly start losing ground against damage and disease. This is why those who live to appear "old" get frail; they just aren't maintaining their robust regeneration against the ravages of the world.

Doesn't that mean Regeneration prevents Aging?

[Caelestion]

Regeneration repairs damaged cells and creates a whole bunch of healthy cells, presumably at the same age as the rest of your body, in the same manner that cloning someone in the middle of their life is a terrible idea if you can't fix the telomere issue.

[Segev]

Doesn't that mean Regeneration prevents Aging?

Who knows? It would be interesting to examine in a fictional work; for game mechanics, they're clearly divorced subjects. If you wanted, you could possibly take non-supernatural regeneration and make it decrease with age. Though it's worth remembering that, other than the "reattach/regrow limbs" thing, regeneration is working with the usual hit point abstractions, so it needn't represent literal wound-closures.

[PacMan2247]

Things like osteoporosis and dementia are disorders caused by the degeneration of bodily systems. Cancer is caused by the unfavorable, rapid mutation of cells within a body, but those cells still originated within that body and share the majority of nucleic acids; it is again a disorder of the normal processes of the body. Psychological disorders tend to be the result of varying combinations of biochemical imbalance and environmental stressors.

As Flickerdart noted, the text of Remove Disease reads thus:
"Remove disease cures all diseases that the subject is suffering from. The spell also kills parasites, including green slime and others. Certain special diseases may not be countered by this spell or may be countered only by a caster of a certain level or higher.
Note: Since the spell’s duration is instantaneous, it does not prevent reinfection after a new exposure to the same disease at a later date. "

The medical distinction between diseases and disorders, to say nothing of the verbiage of the spell, would lend credence to the argument that pathogens and parasites would be dealt with, but not other medical issues. I could see Heal being used to good effect on most disorders, given the broad wording, and Regenerate should address degenerative disorders. Regeneration effects, however, are a bit murkier- would they restore a body to factory condition, or would they be limited to restoring the body the condition it was in when the effect was applied? I could see that going either way; as a DM I'd be inclined to the former ruling, but as a player I'd lean toward the latter.

EDIT: Creatures with inherent regeneration (e.g., trolls, the Tarrasque) always struck me as immune to the effects of aging by the nature of the ability, but that's just my two cents. YMMV.

[Flickerdart]

While not a bad rule of thumb if you choose to use it, this is not a logically sound argument. Just because all examples of blackbirds we see are crows does not mean that only crows are blackbirds.

I'm not talking about examples. The description of diseases, in its entirety, is:


When a character is injured by a contaminated attack, touches an item smeared with diseased matter, or consumes disease-tainted food or drink, he must make an immediate Fortitude saving throw. If he succeeds, the disease has no effect—his immune system fought off the infection. If he fails, he takes damage after an incubation period. Once per day afterward, he must make a successful Fortitude saving throw to avoid repeated damage. Two successful saving throws in a row indicate that he has fought off the disease and recovers, taking no more damage.

These rules do not allow for diseases that are not infectious. Furthermore, all diseases are required to have a number of characteristics, and infection is a required characteristic with the only valid options being "ingested, inhaled, via injury, or contact."

A disease that does not have an infectious vector is not game-term Disease, so a spell that deals in game terms cannot affect it.

[Segev]

D&D, at least, seems to treat "madness" and "disease" as two distinct things, so "psychological disorders" would seem not to be in the scope of remove disease anyway. This would include Alzheimer's and dementia. Let alone the madness induced by some classes. (Alienist, I'm looking at you.)

Cancer still seems to me to fall under "disease" by any definition. While it would take a horrific monster to do this, I imagine that if you performed a blood transfusion from somebody with Leukemia into somebody healthy (and the blood types were otherwise compatible), the cancer would, indeed, spread.

True, part of cancer's insidious nature is that it fools the immune system by being your own cells, but it isn't, itself, an autoimmune disorder and certainly could spread. Just not easily.

As an aside, cancer cultures will, provided they're not killed or starved, generally outlive those from whom they were taken, even if the original host only eventually dies of old age. There is thought that anti-aging technologies might be developed from better understanding cancer.

[DrMotives]

There are a few real-world infectious cancers, so that has some merit. The two I know of are A: one that spreads though domestic dogs as an STD, the cancer cells are originally from a dog generations old that lives on, genetically speaking, as this communicable infection; And B: facial tumors in Tasmanian devils. They fight for dominance with eachother, and the facial tumors, which are cancer cells, spread into new hosts. Terrible disease, they grow large enough to prevent the devils from eating. Conservation efforts quarantine infected devils to stop the cancer, otherwise there is fear that the devil may go extinct from this disease. Either of these would translate into game terms as a disease treatable with remove disease. Although since the dog cancer has a single, known source, I suppose it could inspire a curse or malignant spirit as well.

[Stealth Marmot]

Well consider this, Cure disease doesn't cure ability damage or ability DRAIN, so could something like Diabetes be considered Con Drain and cured by Restoration?

[KillianHawkeye]

Well consider this, Cure disease doesn't cure ability damage or ability DRAIN, so could something like Diabetes be considered Con Drain and cured by Restoration?

I would think that you could cure the damage/drain, but it wouldn't remove the effect, similar to if you regularly healed the damage done by mummy rot.

[Grim Reader]

I would say bacterial infections, virus and prion diseases are all cured by Cure Disease. This seems a reasonable compromise between the game definition, as they can all be contagious under the right circumstances and the spell text. In addition it seems reasonable for the power of a third-level spell.

This would imply that genetic conditions such as cystic fibrosis or autoimmune conditions, as well as cancer would require a Heal spell. Ability damage could represent damage already done by a disease, which requires additional measures beyond Cure Disease.

[Kol Korran]

As a disclaimer, I'm a doctor (Family physician) and have done some biologicla research (Though in molecular plant cell biology).

The question is too big, and D&D is ill equipped to deal with it... Yes, there are infectious diseases, but as has been mentioned, there are many others. And though medicine has come a long way, we are far, far from adequetly understanding many diseases. Some comments:
- Most real world diseases are multifactorial, which means they have several contributing factors: genetics, nutrition, exposure, activity, immunization, and more... We are coming to understand that even diseases that we considered belonging nearly into one of the categories or another, may not be so.

- About Cancer: First of all, it's not one disease. It's a wide and highly complex range of diseases, and though they share some similarities, there are many differences as well. We... don't understand them as well as we thought... We know some cancers are due to genetics... Some have a very high exposure related factor (Nutrition for colon cancer, smoking for lung cancer and a lot more)... Some are known to originate due to infectious contact (Cervical cancer for example, due to papiloma virus contagion)... some are thought/ proved to be autoimmune, we know theorize that mental and emotional stress has a role in the development of some cancers, and we constantly learn more...

- A few subjects that haven't been addressed: What about Orthopedic illnesses? Lower back pain? Sprained ankle? dislocated shoulder? Or skin manifestation- Keratosis? How about shortsightedness? How about minor surgical conditions- Appendicitis? Hernia? How about common blood irregularities- Anemia? Thrombocytopenia? How about mental illnesses that are not as severe as Schizophrenia or such- Panic attacks? Phobia? Personality disorders?

- About Diabetes, or long standing chronic diseases (Metabolic syndrome, various arthritic diseases, COPD, and lots more)- Most of these cause damage to various organs, which can be quite hard to mimic- Diabetes for example, can affect the eyes, the heart, the kidneys, the neural system, the rest of the cardiovascular system and later on wounds are very hard to heal. these affected organs contribute to the general deterioration- when kidney function suffers, so does blood pressure, the heart, lungs and potentially liver... Ability damage (Or drain) may not adequately reflect this, if you seek to mimic real world diseases.

Which brings me to the point- WOULD you like to introduce these into the world, and why? Cancer for example, is quite spread out and common, and quite depressing to deal with. It's a very serious matter, and it's quite possible that one of the players in the group knows someone who has cancer / had cancer/ died of it/ suffers from it. Why would you like to put it in? Or autoimmune disease, which are disastrous, or mental illness (Which I find quite... offensive, being a psychiatric patient myself, with hypomania). Most often when someone seeks to "Explore" such illness, they are interested in what they've heard/ read about in some fiction/ story/ a bit of news. But the reality of dealing with these (Bot has patient and doctor), is... hard, and most of the people who come to play use it for escapism. I'd advise against it, but that's my opinion.

"Regular" infectious diseases, are easier to deal with in the game. Why? A few reasons:
1- Since D&D is supposed to take place in a sort of "old world" setting (Despite magic and so on), these kind of illnesses were what worried most of the old world inhabitants and physicians.
2- They are easier to deal with mentally usually- It something foreign that attacks you (Which you can fight?), other than your own body betraying you/ failing/ or a disease which is so complex and hard that it's no fun to deal with.
3- most infectious diseases, if you survive them, leave little left over damage (Not talking about Polio or others now...) And even that can be reasonably cured with various restoration spells.
4- Since they are infectious, you can evade/ prevent them by avoiding the infectious factor, which is a simpler and better grasped choice than "Avoid smoking, high caloric food, long life exposure to pollutants) and so on...

The "cure disease" spell does raises some questions. Some DMs I've known dislike the spell for the same reasons many players dislike "save or suck/ die" abilities: There is no gradient of success/ failure, and they are an auto win/ lose button. For most games, it can make many illnesses... irrelevant, mostly as an adventure/ arc/ campaign concept. Some potential fixes I've encountered:
1- As has been mentioned- you may cure the disease, but have you obliterated the source of infection? If a certain region has an infectious source, you may get infected quickly, possibly every day? Or someone may be spreading the infection, through water, magic or other means.
2- "Cure disease" doesn't automatically cure any disease. Each spell is for a specific disease. If you encounter a new disease, you'll need to research the spell for it (Which can be an adventure unto itself, and gives the disease time to act and affect the world.)
3- "Cure disease" may cure any disease, but isn't an auto-success. Instead it gives the caster/ subject a hefty bonus on healing/ resisting the illness. Since each disease has it's own DC, some may make the spell a long shot, without also some heal skill ranks.
4- "Cure disease" may require specific spell components for specific diseases. If a new diseases arises, what do you need for it? (Similar to number 2).
5- Make it magically resistant, but that feels too much like DM fiat.

Just my thoughts...

[Segev]

*interesting analysis*With the exception of things that fall under "injury" (mainly dislocated/broken bones), I think all of what you describe falls under the semi-medieval definition of "disease" that we're going to be working with in D&D. If something "ails" you, the doctor was going to be called in to deal with it, and it would be a "disease" if they had no more obvious thing to call it.

So barring it being a curse causing disease-symptoms, it's probably cured by remove disease. Heck, all those skin conditions are likely to be lumped together with Leprosy to the uninitiated. And curing Leprosy is certainly something remove disease is meant to emulate, as one of the miracles Biblical prophets were renowned for. (And a lot of cleric spells are modeled off of Biblical miracles.)



The "cure disease" spell does raises some questions. Some DMs I've known dislike the spell for the same reasons many players dislike "save or suck/ die" abilities: There is no gradient of success/ failure, and they are an auto win/ lose button. For most games, it can make many illnesses... irrelevant, mostly as an adventure/ arc/ campaign concept. Some potential fixes I've encountered:
1- As has been mentioned- you may cure the disease, but have you obliterated the source of infection? If a certain region has an infectious source, you may get infected quickly, possibly every day? Or someone may be spreading the infection, through water, magic or other means.
2- "Cure disease" doesn't automatically cure any disease. Each spell is for a specific disease. If you encounter a new disease, you'll need to research the spell for it (Which can be an adventure unto itself, and gives the disease time to act and affect the world.)
3- "Cure disease" may cure any disease, but isn't an auto-success. Instead it gives the caster/ subject a hefty bonus on healing/ resisting the illness. Since each disease has it's own DC, some may make the spell a long shot, without also some heal skill ranks.
4- "Cure disease" may require specific spell components for specific diseases. If a new diseases arises, what do you need for it? (Similar to number 2).
5- Make it magically resistant, but that feels too much like DM fiat.

I'd go with it curing things just fine. It doesn't prevent reinfection, if there is a source (ghoul fever might return if ghouls attack again; filth fever might return if you keep getting rat bites). It also doesn't help with a plague, unless you can cast it a LOT.

Nor will it help with a weak Constitution; proclivity to fall ill isn't going to change just because you keep getting cured of the illnesses. (This might have been a D&D version of Alexei Romanov's problem, were Rasputin a cleric with remove disease at his disposal.)

[Caelestion]

In D&D terms, haemophilia is probably a curse. Either that or it's part of how the Tsarevich's low Constitution and translated in practice.

[Flickerdart]

In D&D terms, haemophilia is probably a curse. Either that or it's part of how the Tsarevich's every European royal family's low Constitution and translated in practice.

Inbreeding is a hell of a drug.

[Caelestion]

The Queen and Prince Phillip are doing rather well, wouldn't you say? Not every European monarch was crippled with life-threatening genetics.

[Flickerdart]

The Queen and Prince Phillip are doing rather well, wouldn't you say? Not every European monarch was crippled with life-threatening genetics.

>implying Britain is part of Europe

We are not amused

[Caelestion]

Prince Philip is (was) a patrilineal Prince of Greece and Denmark. The Queen's grandmother was German and her great-grandmother was Danish. Prince William will be the first British monarch to be descended from Charles II, rather than merely through the Electress Sophia.

(Yes, I know your comment was in humour, but that's the fun of only marrying other members of royalty. George VI was the first king to marry another Briton since Henry VIII.)

[Segev]

Prince Philip is (was) a patrilineal Prince of Greece and Denmark. The Queen's grandmother was German and her great-grandmother was Danish. Prince William will be the first British monarch to be descended from Charles II, rather than merely through the Electress Sophia.

(Yes, I know your comment was in humour, but that's the fun of only marrying other members of royalty. George VI was the first king to marry another Briton since Henry VIII.)

Clearly, it's time for island nations to unite. Prince William's kids should marry Japanese Imperials. :smallwink:

[Psyren]

Here's an interesting line from Remove Disease we haven't covered yet, which kinda goes along with Kol Korran's analysis:

"Since the spell’s duration is instantaneous, it does not prevent reinfection after a new exposure to the same disease at a later date."

The obvious purpose for that line is telling you can't just cast the spell and then live in a sewer and eat out of the trash with impunity. But "exposure" can be a pretty broad term too. For genetic or hereditary diseases, on that later date you presumably have the same genes you did as when the symptoms originally showed themselves - would that not count as re-exposure? With that line we can justify the spell being incapable of dealing with some illnesses, including things like cancer and haemophilia.


Not sure how RAW/canon this is, but in Temple of Elemental Evil (the crpg version, at least), you can use Heal to cure a guy with dementia.

Dementia would probably be some form of insanity (http://www.d20srd.org/srd/spells/insanity.htm), which Heal can indeed cure by RAW.

[Stealth Marmot]

>implying Britain is part of Europe

We are not amused

Well not ANYMORE apparently...

[Caelestion]

A 26 mile-wide stretch of water is not enough to remove the Sceptred Isle from Europe (geographically speaking). The flooding of Doggerland 10 millennia ago failed to do that, so neither the English Channel nor political short-sightedness will have any further effect. :smallamused:

[Psyren]

Here's an interesting line from Remove Disease we haven't covered yet, which kinda goes along with Kol Korran's analysis:

"Since the spell’s duration is instantaneous, it does not prevent reinfection after a new exposure to the same disease at a later date."

The obvious purpose for that line is telling you can't just cast the spell and then live in a sewer and eat out of the trash with impunity. But "exposure" can be a pretty broad term too. For genetic or hereditary diseases, on that later date you presumably have the same genes you did as when the symptoms originally showed themselves - would that not count as re-exposure? With that line we can justify the spell being incapable of dealing with some illnesses, including things like cancer and haemophilia.



Dementia would probably be some form of insanity (http://www.d20srd.org/srd/spells/insanity.htm), which Heal can indeed cure by RAW.

Quoting myself since the last post on a page often gets missed (and in a probably vain attempt to rerail the thread.)

[PacMan2247]

*snip*

Thank you for providing both an actual medical perspective on this as well as a reminder that various diseases and disorders are loaded topics for a lot of people out there.

[Calthropstu]

Remove disease heals anything that would be considered disease. Cancerous, bacterial, viral, fungal, auto immune and genetic. Dementia would be a disease as it is a slow breakdown of the mind. However, it would not fix something like bipolar, schizophrenia, split personality, psychopathy, or other such that were NOT a result of a disease. Heal specifically states it fixes insanity, however.