May Cause Drowsiness

I've always wondered why potions don't have more side effects.

I've never been a big fan of potions, myself. I dislike single-use items as a general rule, so from a cost-to-value perspective, I'd much rather have a healer in my party than a healing potion on my belt. For a variety of reasons, though, there rarely seems to be a really effective healer in the games I play in, so my groups tend to be reliant on potions. Other players don't seem to think about this very much, but I often wonder what sort of strange and weird chemicals my characters have been putting into their bodies over the years. Some of my characters have had the ability to brew potions themselves, so presumably they know what ingredients go into them, but most haven't and didn't. Even those characters who did know what was theoretically in those potions could never be a hundred percent sure; after all, they were not infrequently drinking potions that they found lost in piles of refuse, deep in dungeons where no living creature had walked in decades. What if the healing potions they were making back then contained poisons? Did the potions have an expiry date, or did they remain just as safe to drink a century after being bottled? I would shudder to think of the horrible things that all of these characters have ingested over my twenty-odd years of gaming, except that none of them ever had so much as potion-induced gas.

In real life, of course, very few of our medicines are side-effect free. Most medications work because they affect some body process or another: they block the function of an enzyme, or they decrease the activity of part of the nervous system, or they impair the body's ability to secrete some substance, or they work through some other mechanism that honestly sounds pretty scary when you say it out loud. Author David Feldman once penned a book entitled, "How Does Aspirin Find a Headache?" The answer, unsurprisingly, is that it doesn't... the aspirin gets throughout your entire body and has the potential to affect every tissue, but at the dose that people take it, it does more good than harm. Aspirin, like pretty much any chemical, has the potential to affect the body, if taken in the right (the wrong?) quantities. In point of fact, that majority of the things that go into modern pills have effects on more than just the target tissue or physiological process. In my professional life, I prescribe a lot of antidepressant and antipsychotic drugs, which are medications that have tremendous potential benefit to the user, at the cost of potentially very unpleasant or dangerous side effects. These side effects come about because the drug molecules don't somehow magically find their way to the neurons that are causing a person to feel depressed. The molecules spread through the entire body and affect tissues all over. Most antidepressants, for example, modulate the body's serotonin to a greater or lesser degree. Serotonin is most famously found in the brain, but it also plays a role in the functioning of the gut, which goes a long way to explaining why most antidepressants have gastrointestinal side effects. Magic potions have major effects on the body; in the case of healing potions, or potions that enlarge or reduce a body, they have huge physical effects. Potions of Remove Fear clearly have an effect on the brain, so why don't they have some of the same side effects as, say, phencyclidine? Why doesn't a potion that cures diseases kill off some of the bacteria in your intestines and cause diarrhea?

Sometimes the negative effects of a medicine don't come from the active ingredient, but from the non-medical ingredients. Some pills contain a bit of sugar; the side effects of a pill that contains sugar will include a rise in your blood sugars, which can be an issue if you have diabetes. The side effects of a pill that contain lactose may include stomach upset if you're sensitive. The side effects of an allergenic dye can be death. I personally have no inkling of what wizards and alchemists use to make their potions, but given that such potions are often brewed hastily on the road, or in laboratories that aren't regulated by any sort of health and safety department,  I sometimes wonder how many of them contain mercury, or lead, or dead bugs or beard hair or any number of other insalubrious additives.

You don't have to ingest a scary chemical to get side effects, though. Researchers testing the efficacy of drugs frequently compare the effects of their drug to the effects of a placebo -- an intervention which, if well-chosen, should have no therapeutic effect. A good placebo is one that contains no chemicals which might have the same effects as the drug in question, so, for example, a pain reliever might be compared to an identical-looking pill made of cellulose, or something else that passes right through the body completely unchanged. The funny thing is, even when we pick a placebo that's completely ignored by the body, that isn't in any way absorbed, modified, or metabolized, people can still get side effects from them, most commonly nausea, dizziness, and heartburn.

And no, by all rights, water that's been sitting in a bottle for two hundred years shouldn't still be safe to drink unless it was very, very pure when it went in. Even water distilled and cleaned to the very best of modern ability has an expiry date.

For better or worse, all of this gets the same explanation as usual: magic. Maybe a Cure Light Wounds spell doesn't cure diseases per se, but it apparently has some innate property that protects you from developing a disease caused by the potion itself. Maybe the process of creating a potion intrinsically nullifies the harmful effects of the sulfur or ground-up zombie bone or whatever that went into it. Maybe some of the harmful effects just take too long to develop and don't become apparent until after the campaign is over, like the brain damage that comes from having left the potion in a leaded-glass bottle for a month. On the other hand, it might be jolly good fun for the storyteller to occasionally have there be some negative consequence to putting unknown chemicals into your body, just to keep the players on their toes. At least in real life, any pill or treatment that claims to have zero chance of side effects usually has the same chance of a beneficial effect.

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on October 13, 2013. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system.