This week in Revolutionary War history, let’s check up on what was going on 250 years ago in the Thirteen Colonies. Last week, preparations continued as the inevitable British attack on New York drew near. The newly declared United States of America has taken action against Loyalists, as fear of sabotage soars high, especially in the merchant stronghold of New York.

            News of the Declaration finally arrives in London, being published in local papers and disseminated across the Old World. Finally, Americans, no longer bound by British laws keeping settlers to the East of the Appalachians, begin to move into Cherokee lands.

            On August 16, 1776, George Washington writes to Representative of the Continental Congress Elbridge Gerry of Marblehead, Massachusetts, saying, “The enemy have given us much time to collect our strength, and erect the necessary works of defense — the militia from Connecticut are coming in fast,” signaling hope in the city’s defense. However, he adds, “the enemy will outnumber us.”  

            He finishes, “Our troops are very sickly, but those which are in health are in high spirits.” Gerry is a delegate in Congress and traveled alongside fellow delegate Samuel Adams to New York a few weeks earlier to inspect conditions.

            That same day, Americans launch rafts set alight towards the HMSPhoenix anchored in the Hudson River. The flaming barges miss their targets, but the British ships move back down the river.

            On August 17, Washington releases the Proclamation for the Evacuation of New York, where he sets forth the plan to avoid civilian casualties in the upcoming battle.

            It reads: “Whereas a bombardment and attack upon the City of New York, by our cruel, and inveterate enemy, may be hourly expected: and as there are great numbers of women, children and infirm persons, yet remaining in the city, whose continuance will rather be prejudicial than advantageous to the army, and their persons exposed to great danger and hazard: I do therefore recommend it to all such persons, as they value their own safety and preservation, to remove with all expedition, out of the said town, at this critical period.”

            Also on that Saturday, Washington writes to the New York Convention governing body, noting more worry over the upcoming “bloody conflict.” He worries the remaining civilians, and their inevitable hardship in the assault, will affect his low-disciplined army.

            He says, “When the Men of War passed up the river the shrieks and cries of these poor creatures running every way with their children was truly distressing and I fear will have an unhappy effect on the ears and minds of our young and inexperienced soldiery.”

            The next day, the HMS Phoenix brings its revenge, pushing north up the Hudson with the HMS Rose as the sound of cannon fire echoes across the river as the two ships rejoin Admiral Richard Howe’s main fleet.

            On August 20, the diseases sweeping through the Continental Army put General Nathanael Greene on bed rest. Greene is in command of the troops on Long Island, and his incapacitation requires General John Sullivan to replace him.

            Also on that day, the Continental Congress debates proposals for the national seal. Of the finalists, Benjamin Franklin proposes “Moses standing on the shore, and extending his hand over the sea.” Thomas Jefferson proposes, “Pharaoh sitting in an open chariot, a crown on his head and a sword in his hand passing through the divided waters of the Red Sea in pursuit of the Israelites.” And Pierre Eugene du Simitiere proposes, “a rose — for England, a thistle for Scotland; a harp for Ireland, a flower de luce or for France, the Imperial Eagle Sable for Germany, and the Belgic Lyon Gules, for Holland. (These being the six principal nations of Europe from whom the Americans have originated).” Years of debate remain, as the symbol of the bald eagle has not yet taken hold.

            As tensions across the new United States flare hotter, less than a week remains before the battle begins.

This Week in Revolutionary War History

By Sam Bishop

On July 16, the FDA approved enlicitide (brand name Lipfendra) to lower LDL cholesterol in people with high cholesterol. For people with very high cholesterol, this is a big deal.

            We have known since the late 1950’s that elevated cholesterol was associated with an increased risk of heart attack, but the drugs then available to lower cholesterol were not very effective and had very annoying side-effects.

            The first statin, lovastatin, was approved by the FDA in 1987 and it was a real “game changer.” There was finally a class of medicines that were well-tolerated by most people and very effective at lowering cholesterol. In 2026, seven statins are commercially available, most now available generically and thus reasonably priced. The evidence that these drugs not only reduce cholesterol but also reduce heart attack risk is overwhelming.

            A minority of patients at risk from high cholesterol cannot take statins, usually because of an allergy that leads to liver damage. Some people take them safely but do not get adequate cholesterol lowering, even at high doses. The non-statin cholesterol-lowering drugs (ezetimibe, bempedoic acid) are not nearly as effective as statins and are usually added to a statin rather than used alone.

            A true breakthrough was the development of what are called PCSK9 inhibitors, a totally new class of drugs that are very powerful at lowering cholesterol and which have now also been shown to reduce heart attack risk. These can be safely used in people who cannot take statins, though they are most often used as add-ons to statins in patients who have not reached desired cholesterol levels on the statin.

            The two big downsides to PCSK9 inhibitors are that they are VERY expensive (list price around $6000/year) and that they must be given by injection.

            The new drug enlicitide also works by inhibiting PCSK9 but comes in pill form, taken once daily. It will not be cheap; estimated list price is $3800/year.

            Who should consider taking this new drug? If you cannot take a statin and you need to get your cholesterol down, or if you are on a full dose of a statin but you have not reached the cholesterol goal you set with your doctor, you are a candidate for a PCSK9 drug. If you would rather take a daily pill than an injection, enlicitide may be the answer.

            Since safe, effective and cheap statins are the right choice for most people with high cholesterol, expect your insurance company to balk at paying for a much more expensive drug. If you need one, your doctor will have to convince them that you do.

            Edward Hoffer MD is Associate Professor of Medicine, part-time, at Harvard.

What Does The Doctor Say?

By Dr. Edward Hoffer