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You can change how emphasized words are spoken using css assuming the device supports the standards... you can also change how emphasized words are displayed with css.
The defaults of <i>/<em> and <b>/<strong> are the same (italics and bold respectively) but they can be changed. So Wolfe's assertion that there is no difference is a little misleading. There is a semantic difference. <i> is for a visual only presentation (however you want it to look), while <em> is whether the word is supposed to be emphasized (typically when read aloud, but even when you are visually reading the word - I can assign an emphatic voice in my mind while reading...) DNSB gave a good example in #9.
Whether or not anyone has used a device that sufficiently differentiates the semantic coding does not invalidate the difference in coding...
I also choose to code my books with the assumption that meeting accessibility standards, as well as proper use of semantic tags, will just make the books better as/when devices improve their support... I also won't have to go fix the books if a major portion of the world passes laws requiring book producers to follow accessibility standards (like the EU did)....
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