For those people who are interested in ebooks and the technology market the past few days have been 'interesting' to say the least.

It started when Amazon pulled all the ebooks published by Macmillan from their Kindle store.

Speculation ran rife - it eventually seems to have boiled down to Macmillan wanting to set the price of their ebooks and adopt an 'agency' model while Amazon wants to keep the status quo.

I shall leave it to the wonderful John Scalzi and Charlie Stross to explain.

Do I think Macmillan (or anyone else) will be able to sell $15 ebooks? They could; after all, they sell $25 hardcovers (and similar amounts for ebooks, depending on the retailer). Now, some people won’t spend that much for a book, so they pick up the book later when it’s an $8 paperback. That’s fine, too.

Likewise, I think it’s fine to attempt to charge $15 (or more) for an ebook for a brand-spankin’ new release to service the folks who just can’t wait, drop it to a lower price point (say, $10) later on in the run, and then drop it again to $8 or so when the paperback hits.

That’s how I would do it, in any event. Would it work? Hell if I know. But that’s not to say it (or some other pricing scheme) is not in a publisher’s interest to try. And to be blunt about it, it’s in my interest as an author as well, because, you know what? My royalty is a percentage of the sale price. I have a mortgage, I have a kid to send to college, I have an addiction to games that allow me to shoot zombies in the head. I’d like money for those, please.

It’s not unreasonable to test the market and see what it will bear.

John Scalzi

This whole mess is basically about duelling supply chain models. Publishing is made out of pipes. Traditionally the supply chain ran: author -> publisher -> wholesaler -> bookstore -> consumer. Then the internet came along, a communications medium the main effect of which is to disintermediate indirect relationships, for example by collapsing supply chains with lots of middle-men.

From the point of view of the public, to whom they sell, Amazon is a bookstore. From the point of view of the publishers, from whom they buy, Amazon is a wholesaler. From the point of view of Jeff Bezos' bank account, Amazon is the entire supply chain and should take that share of the cake that formerly went to both wholesalers and booksellers. They do this by buying wholesale and selling retail, taking up to a 70% discount from the publishers and selling for whatever they can get.

Their stalking horse for this is the Kindle publishing platform; they're trying to in-source the publisher by asserting contractual terms that mean the publisher isn't merely selling them books wholesale, but is sublicencing the works to be republished via the Kindle publishing platform. Publishers sublicensing rights is SOP in the industry, but not normally handled this way -- and it allows Amazon to grab another chunk of the supply chain if they get away with it, turning the traditional publishers into vestigial editing/marketing appendages.

Charlie Stross

I suggest that you read both blog posts (and the comments) to get a full handle of the situation.

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I have two things to add to this, one is where I see Apple in all this, and another about my experience with Amazon.

Firstly, I suspect that this has a lot to do with the Apple iPad, while it's not confirmed I suspect that Apple are going to follow a similar pricing systems with ebooks as it's App Store. This is the 'Agency' model where the owner of the book lets Apple list it on their store and then the money is split 70%/30%, Apple getting the 30% for the running of the store.

The important part of this is that the publisher sets the price. If they want to charge £25 for an ebook and the market supports that then that is what they will do - if they want to sell the same book for £2.99 then that may end up making more money for the publisher (and ultimately the author).

It's all about the free market and finding what price the market will bear.

Take, for example, the successful experiment by my publishers The Friday Project. They sold 65 times the number of ebooks at £2.99 rather than at the RRP. And didn't cannibalise physical book sales either.

There are good arguments that ebooks shouldn't cost as much as physical books - but allowing publishers to set their own prices ultimately lets the market, by which I mean 'people who buy ebooks', affect the price.

(I don't intend to get into 'windowing' at the moment - while important it is somewhat tangental to my above discussion)

If Apple don't follow this model for their EPUB book store, then people will continue to make their books into standalone apps that do sell under this model...

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How does this affect me?

Well, as I think that Amazon are seeking to monopolise the ebook market and protect practices that are unfair and anti-competitive, I shall simple stop buying from them. I have a Sony Reader (well, I have two) and while the back catalog of books for that device is smaller, I suspect that this might change. I suspect that publishers will stop looking at the proprietary Amazon format as a good deal and will instead move to the more open EPUB format that can be read on more devices (including the Sony Reader the Cool-ER and the iPad).

What is interesting is that Amazon are opening up the Kindle to it's own 'App store' - I would be very surprised if one of the first applications isn't something that allows you to read EPUB files on the Kindle, something that is impossible at present.

It also wouldn't surprise me to see Amazon ban such an application*.

Because of this anti-competitive, protectionist and downright icky behaviour, I shall no longer be linking to, or affiliating myself with Amazon. Rest assured that they will be quaking in their boots at the thought of the pennies that they will be losing from me.

Well, they won't - but at least I'll feel better.

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As an aside - I note that Amazon are selling my two ebooks on their Kindle store without the permission of me, or my publisher. My publisher has already asked for them to be taken down (when the book was launched), as of Sunday the 31st of January this has not happened.

I know I can be bloody minded - but if I were my publisher I'd be phoning the lawyers on Monday morning...

My books, as always, are available for free download in multiple formats (including Kindle) from Manybooks.net

Blood, Sweat and Tea

More Blood, More Sweat and Another Cup of Tea

Please don't buy them from Amazon for $12 (or whatever the cost)

As I said - interesting times, and it'll be even more interesting to see how this all shakes out. After all, who would have thought that Apple would be the one supporting a free market?

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*The problem is that the DRM that Amazon uses is not allowed to be used on devices that can use other DRM formats - which may lead to new and interesting legal battles.

UPDATE: Slight edit to make it explicit that Amazon shouldn't be selling my ebook, they are fully able to sell the physical edition of my books.

We had a student with us for the past two weeks. It was her first ever time on a real working ambulance so she had a more than a few 'firsts'.

She saw her first dead body.

She drove for the first time with the blue lights and sirens.

She used the radio for the first time, talking to Control.

She spoke to her first patient, calmed her first scared patient.

She met her first alcoholic (who was nice) and her second alcoholic (who wasn't).

She got cut out of her first car, holding the neck of the driver who'd crashed it.

She filled in her first accident report form (neither her fault, nor connected with the previous point).

She took her first 'real' blood pressure, her first blood sugar reading, her first pulse and listened to her first chest.

She carried her first patient down a couple of flights of stairs.

She filled up and paid for her first tank of diesel.

She dealt with her first case of domestic violence, and her first heart attack.

She also ganged up with my crewmate and bullied me like an expert - but I'm used to having that effect on women.

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I sometimes forget, having seen most things, done most things and gotten bored of most things; how interesting this job can be. Sometimes it helps to look through the eyes of a student to see that we do have a job where every day contains a story.

It's very easy to get disillusioned with the job, I know I have - but when you are teaching someone, the tricks and tips that they don't teach in school - the ways to look at patients, the ways to talk to them to ease their fears, the ways to not get burnt out too quickly - well, then you get a chance to take a step back and realise what it is you enjoy about the job.

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Blogging should be more regular now as I've attacked my old computer with a screwdriver and now have a (much slower) working machine. If you've sent me an email in the past month you should be getting a reply soon.

She's in her late eighties, she has arthritis, sores covering her body and brain cancer.

Every movement causes her pain.

She's been moved from one hospital to another - all for her own benefit, but she only seems to stay in one place for a few weeks before going to somewhere more suitable.

She's getting good care, people are looking out for her, the place where we pick her up from is a nice unit - she's going back to the local hospital because of a new symptom that is causing her pain.

We put her on our trolley and wrap her up in our one remaining blanket, I 'borrow' a pillow from the unit. We don't have pillows, neither does A&E.

She worries that she has left something in one of the cupboards so, before we go, I make a point of opening all the doors and showing her that they are empty.

She's a little forgetful, but otherwise has insight into her condition. She's a 'proper' old East End girl. Good natured mild swearing, a little joke here, a little ribbing there.

I instantly like her.

We wheel her out into the cold but, once the ambulance doors are shut, she soon warms up.

I sit in the back of the ambulance and chat with her, she tells me about her son and how he works shifts, so he can't visit as often as she'd like.

She tells me that she really wants to go home but can't because there is no one there to look after her.

I'm holding her hand as she turns her head to me and looks at me with blue eyes.

'I'm eighty nine, I've had enough, I'm tired', she tells me.

I blink the moisture forming in my eyes away.

I know what she means.

She knows that I know what she means.

Queen's Hospital in Romford is closed

King Georges Hospital, a bit closer to my station is closed.

Whipps Cross hospital remains open for more of the day, but then closes.

Newham, Homerton and the Royal London are now the only hospitals in East London accepting patients.

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Queen's and King Georges being closed in the east means that ambulances local to them are bringing patients to Newham.

Crews local to Newham (i.e. me) are being told to take patients to either the Homerton or to the Royal London.

I don't know what crews local to the Homerton or Royal London are being to to do.

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I pick up a patient a stone's throw from Newham hospital, he has chest pain that could be cardiac in nature. I have a bit of job persuading him to come to hospital, but he finally agrees that the only definitive test is some blood tests.

As directed I contact Control to see where I should take him. They tell me to go to the Royal London hospital.

I tell the patient - he gets off the trolley and walks out of the ambulance, he doesn't want to go to that hospital and I had a hard enough time getting him to agree to go to the local hospital.

I complete my paperwork and then fill out a clinical incident form. If he drops dead it'll be me in front o the coroner, not my bosses.

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I spoke to one of the crews that is local to Queens hospital, they tell me that the A&E department is full of patients from last night. They are still waiting to go up to the wards to get the treatment that they need.

But there aren't enough beds.

Queen's hospital was only built in the last two years - you'd assume that it would have been designed and funded to meet the needs of the local people.

I can understand why the A&E closes, it's a clinical risk to be so overcrowded.

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But it's also a clinical risk to be driving patients across London, it's a clinical risk to have patients decide that they want to stay at work rather than be driven miles to a strange hospital.

It's a clinical risk that I can't take a patient who has multiple problems that the local hospital knows all about to that hospital (although in that case I successfully argue my case with Control, at least I think I do, they don't reply after I tell them why I'm going to the local hospital instead of one unfamiliar with my patient).

I'd say that it's a clinical risk that ambulances are tied up with longer than normal transports - this means it takes us longer to go clear at hospital to get to our next patient. And it's normal for us to be holding calls for ambulances to come clear - how many more calls were we holding today?

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Once more, a lack of capacity means that those of us on the bottom of the pile get the most crap - and in this case it's not the ambulance service, it's the patients.

The answer is simple, but it costs money. Money 'better' spent on keeping bankers in jobs and fighting wars that don't concern us.

But of course, I'm just a stretcher monkey, what do I know?

Good News

Patients suffering an out of hospital cardiac arrest in London now have more chance than ever before of being resuscitated by staff, according the latest Service figures.

The report, published by the Clinical Audit & Research Unit (CARU), also shows the Utstein* survival rate is up to 15.2 per cent from 12 per cent the previous year.

So, if you have a cardiac arrest in London (for certain values of cardiac arrest), you have a 15.2% chance of survival. Which is great but won't result in us getting any more funding. Well done everyone involved, and well done to the new CPR protocols - I've personally noticed a difference with the 30:2 compressions.

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Bad News

For the first time in its history the Service has responded to one million incidents in a single calendar year.

The Service has already attended over three per cent more incidents than in the whole of last year (968,952), with the busy New Year's Eve period still to come.

Chief Executive Peter Bradley said: “To attend one million incidents in a single year is an amazing milestone and one that no other ambulance service has ever reached.

“Every member of staff can be proud of the contribution they have made towards helping us to reach more patients more quickly than ever before.

“Demand on our Service has risen steadily over the years , and this is something experienced by ambulance services nationwide. We continue to work to find innovative ways of offering more appropriate care pathways for our patients. The ability to offer some of our callers telephone advice or to transfer them to NHS Direct is allowing us to save thousands of traditional ambulance responses each year."

The millionth incident was to a patient suffering chest pain in Tower Hamlets. A Poplar ambulance crew and a HART single responder attended. The patient was taken to hospital.

This is what I meant when I previously mentioned that our chief executive sounded proud that we go to more than a million calls. Is that something we should be proud of, or rather something that we should be worried by? And these are the calls that ambulances are sent on, not the ones where telephone advice refuses an ambulance.

Someone please explain to me how this is a good thing, especially if we aren't increasing the number of ambulances and staff on the road?

As an aside, half of my workload is 'chest pain in Tower Hamlets', I'm willing to bet that it was a cough or bellyache, or maybe a bit of 'flu'.

We get another one of our bog standard 'nan down' calls. An elderly person, not too spry on their feet has fallen over and needs us to come and pick them up again.

The door is opened by her son, two eyes stare at us suspiciously from over a foot long beard. A half smoked cigarette is dangling between his fingers.

'Come in then', he says gruffly then, indicating his mother's bedroom, he disappears into the living room to continue smoking.

His mother is on the floor in an awkward position. She's wearing a filthy dressing gown, she obviously hasn't washed in some time and her toenails have grown so long that they have curled under her feet. I'm later told that she also smells.

She is in quite some state of neglect.

We check her over while she remains on the floor, she's not confused, just a bit frail - she tells us that she has no pain anywhere so we set about standing her up.

I put my hand on the wall to steady myself, it comes away yellow with nicotine.

She stands up, almost unsupported, but can't seem to straighten herself up. She tells us that there is now a tiny bit of pain in her hip area, but that it's probably from where she fell.

She can't walk, she can't stand up straight. I'm ready to take her to hospital if only to get a swarm of support workers to come to her house and make things better for her.

'A little bit sore, not too bad', is how she describes the pain in her hip. We pop her in our carry chair and take her out to the ambulance. Putting her on the trolleybed we notice the shortened and rotated leg - an indicator of a broken hip.

Because of the cluttered bedroom and the way she was laying we couldn't have noticed it before, because of her not complaining of any pain we didn't suspect it. I'm still not sure - it looks like a broken hip, but from what the patient says it doesn't sound like a broken hip.

We'll treat her for a broken hip - it's a benign treatment (mostly splinting), so even if we are wrong it won't have any side effects.

Before we go off to hospital I return to the house to tell the son what we are doing - he's smoking a new cigarette.

'Yeah, whatever, bye, I'll call later'.

I leave him to return to the living room.

Now, I know I'm not a psychiatrist, but I do have a fair amount of experience with people who have mental illness. In this case the smoking, the personal neglect, the 'attitude' - it makes the word schizophrenic float to the front of my mind. It would explain the living conditions, both are ill - one of the body, one of the mind.

We drop our patient off at the hospital - it's one of the excellent nurses in charge so I know I can trust her to rally the army of social workers, home carers, occupational therapists and whoever else to get this woman the help she needs.

The next day I ask the nurse what happened to our woman - she did have a fractured hip, a bad one at that, yet pulled herself off the trolley onto a commode without a sign of pain. The nurse also suspected that our patient had jaundice until she realised that it was an all over body stain of nicotine.

The son did phone later and on being told that his mother had broken her hip, seemed untroubled.

I hope that she's not in the 20%-35% mortality rate. But I know that should she survive she'll get the help she needs.

And if the son has slipped through the net, maybe he'll get some help as well.

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I'm not dead - just a combination of spotty internet connection and a deceased laptop has meant that I've been buggered by circumstance.

Now I'm deciding if I should wait until the end of January for the rumoured Apple event before getting a new Macbook Pro. That and, of course, how the hell I'm going to afford it...