They don't have effect on the content [typically] but television ratings are what networks use to charge advertisers.
The number one show for the 2016-2017 season was The Big Bang Theory [when you exclude sports programming] so CBS can charge advertisers more money for ad space since they know an average of 19 million people watched this past season as opposed to a shows on The CW for example whose highest viewed show was Supergirl seen by an average of 3 million people.
So bottom line, ratings affect whether TV shows remain on the air or not. If a show can't make advertising money for its network, it gets cancelled.
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In America at least, you need to have a Nielsen box which records what shows you watch. The average person's viewing habits really have no effect on the ratings on TV shows. I have read that somehow ratings are tallied from DVR playbacks but I haven't the foggiest how that happens as I don't own a DVR.
Most can be considered "fake". Much of the supposed antagonism and many of the feuds are scripted. The final presentations are heavily edited and show only the material that the producers choose to include. Ratings factor heavily in the outcomes.
According to Nielsen and other companies that did television ratings, NBC had the two top programs-- Seinfeld (a comedy) and ER (a hospital drama).
These are a couple i remember from the 70's and 80's:Starsky and HutchMagnum PI
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