From a publisher's point of view, I found that a reader's default settings wreaked a lot of havoc on image placement and captions. My guess is that 75% of the time the publisher knows the optimal way to present the content on a device. For the 25% of the time that the reader tweaks things, it mainly has to do with font size and to a lesser extent reducing margins to permit maximum word count.....
I don't have a problem with reader defaults overriding publisher defaults on font and size, but the margins make it more difficult to figure maximum width of things. that is a real problem.
As Liz Castro said, support for media queries will fix a lot of these problems.
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