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So how is <em> and <strong> visually different to <i> and <b>? The answer is there's no difference. <i> shows The Lancet exactly the same as <em>. And as you see in your post and this post, italics are being used and not emphasis.
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Yes, I know. But when I started in web design it was considered bad practice to use i and b as everyone was moving to em and strong. So that is my habit as yours is for i and b. I wouldn't be surprised if I and b are chucked in the bin again some time.