Diseases were vestigial in 2014. They only existed because curing diseases has always been a thing paladins could do. But if there was a paladin in the party, diseases were trivial to cure. So, the entire exercise just felt like a weird pantomime where DMs were including diseases just to humor the Paladin player, and Paladin players were spending 5 points of Lay on Hands to cure diseases they knew only existed to humor them. By getting rid of diseases as a specific codified category of thing, we are free of that silly artifice. Now, diseases can still exist as bespoke game constructs that include their own rules for how they can be cured, and they can therefore always be as easy or as difficult to cure as the narrative demands.
I agree with this. In our home game, a diseased party member drove a significant portion of the plot for almost a year, and the first thing they discovered was that it was not curable by the “conventional” methods. At my current school campaign, one player has written a disease into their backstory, and it will soon become a focal point of the campaign.
So with the 2014 rules, whenever you wanted a disease to matter, you just designed it so that lay on hands and restoration didn’t work because reasons, making cure disease into a ribbon ability. I suspect the 2024 DMG will instead address disease solely as a plot point, much like traps, etc.
I do wonder if this is a step in the direction of disease being a much more serious long term issue that isn't easily magicked-away. If so I'd be in favor of that.
I suspect what it means is that each type of disease that does exist in the game will spell out how it is removed (varying from trivial- to quest-level). Which, given (as others have pointed out) the number of times
cure disease/restoration spells/paladin abilities have been excluded throughout the editions, has been the de facto situation already.
And I agree -- disease was codified in 1e AD&D and treated as a significant part of the play experience (and like level-up training or weapon vs. armor charts, individual mileage may have varied). Since then, the game has been very waffley about how much of a thing it is supposed to be*. Usually as a plot device (the plague town), and usually either untreatable with the mid-level abilities specifically given to deal with diseases, or spreading too fast to cure with X/day abilities.
*outside of individual monsters inflicting it on hits, which as often as not required different treatment from the baseline anyways.
Diseases, like Curses or Geasa, are wonderful fantasy worldbuilding effects, but run into issues when gamified. If too easy to cure, they just become a resource cost. If too hard*, the eliminate** the 'cure the village just because you are good people' plot. It almost inevitably*** works best for the cure to be the source of following a plot hook (be that a supply of medicine, a secret rare herb, or rare components for a highly-specific
cure disease spell/ritual).
*say costing xp or major gp investment, etc.
**or at least become a 'screw you, player, for making a character who cares about nameless townsfolk I just invented to give you this hard choice' moment.
*** unless your players would immediately shout 'RAILROAD!' and rebel.
D&D kinda hamstrung itself early on by making all spells easy to cast using daily slots; with the only way to make them more costly being staggering expenses like costly components, caster laid up for extended periods, (in AD&D) aging the caster, (in 3e) xp cost, or the like.
Fascinating. I have an entire PDF of normal and magical diseases I've been working on for sale.....I might have to rethink this.
Why? It's giving you free rein to do what you want, unburdened by what WotC is doing. None of the spells or class abilities you might have been thinking of using as cure options have been removed. The diseases you were going to create weren't present to begin with. You can do everything you intended to do, just without any
'instead of the existing disease list in the core rules, you might instead enjoy my...' verbiage necessary.