The Island of California
On creating new maps for South Asian health
One of my favorite hobbies is maps, it is one reason I love to explore new parts of the world. As a child, I had a book that contained regional maps from around the world, not just political boundaries, but maps drawn by topography, water basins, and trade routes. As a consequence of growing up in the house of a civil engingeer, I fell onto road maps that evolved with time, as a city expanded and reconstructed itself, maps would show new locations and roads previously non-existant. I learned early on that a map is not the territory; it is an argument about how the world should look.
History is filled with maps that were drawn from a specific perspective, only to be proven completely wrong.
Consider Terra Australis Incognita. For centuries, mapmakers drew a massive, non-existent continent at the bottom of the globe simply because philosophers believed the world needed “balance.” They assumed that for the Northern Hemisphere to exist, an equal mass must exist in the South.
Then there was the Island of California. For over a hundred years, maps depicted California as detached from the American mainland, floating on its own. It was a fiction born of wishful thinking and bad data, yet it persisted because it was easier to copy the mistake than to survey the coast.
And perhaps most striking reminder, the Mountains of Kong. From 1798 to the late 1800s, maps of Africa showed a massive mountain range stretching across the continent. It never existed. Mapmakers simply drew it there to fill a blank space they didn’t understand, preferring a detailed lie to an honest void.
Now consider a man who inherits a vast estate but has never walked its grounds. He knows it only by the old surveyor’s charts, boundaries drawn by someone else, for someone else, long ago. The land has shifted. The river has moved. The forest has grown where the meadow was marked. But he trusts the map because it is the only map he has.
This is the position of South Asian patients in modern medicine.
The reference ranges were drawn for other populations. The diagnostic thresholds were calibrated on different bodies. The treatment protocols were optimized for different metabolisms. And yet we trust them; because they are the only maps we have.
At Grasshopper Medicine, we decided to walk the grounds.
We started on this journey twelve months ago, and over the past year, we’ve been building a new framework for understanding South Asian physiology, not by importing conclusions from research that excluded us, but by returning to first principles. We started at the smallest scale and worked outward. Organelles. Cells. Tissues. Organ systems. Each layer examined on its own terms before asking how it connects to the next.
The logic is simple: you cannot build a house on a borrowed foundation. If the baseline assumptions are miscalibrated, everything downstream, diagnosis, risk stratification, intervention, inherits that error.
What emerges is not a picture of a population that is mysteriously sicker. It is a picture of a population whose biology was never properly mapped in the first place.
In the coming year, we go deeper. Build an architecture and framework that is actionable. We’re also working on building something truly powerful that brings what we have done to the millions around the globe.
The goal is and remains optimizing south asian health. And we can do this through a precision medicine protocol rooted in South Asian biology, designed to intervene before the cascade becomes irreversible.
We are drawing a new map. Building our own surveys, as we are all cartographers now.
-omar