Far as the TV show surviving: well, it's doing ratings gangbusters right now. It's more expensive than Deadwood, but it's pulling in a lot more eyeballs, too. To the point where they're not just putting support behind it, they're looking at other fantasy properties. (American Gods is getting made into a series; no, it won't be nearly as expensive as GoT, but it shows HBO's still seeing dollar signs in the genre.)
Per the specific episode:
Well, I'm going to start by declaring a moratorium on season 1/book 1 spoiler tags. If you have somehow made it this far without knowing all the major twists of the first season, it's time you stopped pushing your considerable luck and got out of the thread.
And minor, untagged spoilers of this week's episodes and the equivalent bits in Clash of Kings follow.
So okay. Changes:
While I understand that it's simpler to have a one-liner explaining that Stannis got Ned's letter, it bothers me. In the book, it turns out that Stannis was the FIRST to figure out Joffrey wasn't Robert's son and set Jon Arryn on the trail.
Also, I forget -- who did Ned give the letter to? I know Cersei tore up Robert's will, and I thought they intercepted the letter too (pretty sure they did in the book). I could see Littlefinger having it delivered anyway, but not Varys. (Varys wants unity. Littlefinger's motivations are less clear -- we know he's got a Napoleon complex and an unrequited childhood crush, but those don't explain everything he's done five books in.)
A change I DO quite like: the scene with Cersei and Joffrey at the end, and the clear implication that HE'S the one who gives the order. It makes Joffrey less stupid and Cersei less evil.
Best bits, per usual, were Tyrion's. Points off for actually saying, in dialogue, "You love your children. It's your one redeeming quality." but his followup line mostly redeemed it. I think the best part was his delivery of the line about how it must be hard to be the disappointing child for a change -- he could have presented it mockingly, but that it's the only thing he says that actually sounds completely sincere gives it all the more depth -- and sting.
Also, Craster and the Old Bear didn't take off their clothes when they started delivering exposition, and I think we can all breathe a sigh of relief on that one.