> I find it fascinating (and a bit worrying) they are still basically attempting to optimize the same two approaches that were developed in the 50s/60s, tokamak and stellarator.
This would be a bit like worrying that aerospace engineers are still optimizing wings. Like wings, tokomaks/stellarators are the best tools for the job, as dictated by the underlying physics of the systems in question. Basically, donut-shaped magnetically-confined plasmas "leak" into themselves, rather than out into the world.
> Many people have spent their whole careers on it and have died without making significant progress.
This is a popular view that is entirely wrong. The figure of merit, which is the triple product of confinement time, density, and temperature, outpaced Moore's law right up until a gain of about 0.95, when the magnetic technology of the day caused the necessary size increase to put ITER in the realm of international cooperation. ITER absolutely will produce more power than it consumes. The plasma physics are just that well understood. The problem is size.
MIT have recently worked out that a new breed of superconducting magnets can more than double the available field strength, resulting in a 16-fold reduction in reactor size (due to a 4th power gain in confinement strength as a function of field strength). They hope to achieve a gain of about 2 with a university-scale reactor before ITER, designed with the magnets available at the time, is complete.
Most, if not all, of the above comes from https://www.youtube.com/watch?v=L0KuAx1COEk. ARC and SPARC, the MIT reactor concepts, are the most exciting thing I've heard about in...gosh, I guess my whole life. They could pull it off. If they do, we could save the planet with fusion-powered CO2 scrubbing. We could avert disaster.