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Brain Stimulation is transforming neuromodulation, from TMS and DBS to closed loop devices, targeting neural circuits for addiction, depression, Parkinsons, epilepsy, and chronic pain, powered by advanced imaging, AI analytics, and the NIH BRAIN Initiative.

Key Points

Brain stimulation uses pulses to modulate neural circuits, easing symptoms in depression, Parkinsons, and epilepsy.

✅ Noninvasive TMS and invasive DBS modulate specific brain circuits

✅ Closed loop systems adapt stimulation via real time biomarker detection

✅ Emerging uses: addiction, depression, Parkinsons, epilepsy, chronic pain

In June 2015, biology professor Colleen Hanlon went to a conference on drug dependence. As she met other researchers and wandered around a glitzy Phoenix resort’s conference rooms to learn about the latest work on therapies for drug and alcohol use disorders, she realized that out of the 730 posters, there were only two on brain stimulation as a potential treatment for addiction — both from her own lab at Wake Forest School of Medicine.

Just four years later, she would lead 76 researchers on four continents in writing a consensus article about brain stimulation as an innovative tool for addiction. And in 2020, the Food and Drug Administration approved a transcranial magnetic stimulation device to help patients quit smoking, a milestone for substance use disorders.

Brain stimulation is booming. Hanlon can attend entire conferences devoted to the study of what electrical currents do—including how targeted stimulation can improve short-term memory in older adults—to the intricate networks of highways and backroads that make up the brain’s circuitry. This expanding field of research is slowly revealing truths of the brain: how it works, how it malfunctions, and how electrical impulses, precisely targeted and controlled, might be used to treat psychiatric and neurological disorders.

In the last half-dozen years, researchers have launched investigations into how different forms of neuromodulation affect addiction, depression, loss-of-control eating, tremor, chronic pain, obsessive compulsive disorder, Parkinson’s disease, epilepsy, and more. Early studies have shown subtle electrical jolts to certain brain regions could disrupt circuit abnormalities — the miscommunications — that are thought to underlie many brain diseases, and help ease symptoms that persist despite conventional treatments.

The National Institute of Health’s massive BRAIN Initiative put circuits front and center, distributing $2.4 billion to researchers since 2013 to devise and use new tools to observe interactions between brain cells and circuits. That, in turn, has kindled interest from the private sector. Among the advances that have enhanced our understanding of how distant parts of the brain talk with one another are new imaging technology and the use of machine learning, much as utilities use AI to adapt to shifting electricity demand, to interpret complex brain signals and analyze what happens when circuits go haywire.

Still, the field is in its infancy, and even therapies that have been approved for use in patients with, for example, Parkinson’s disease or epilepsy, help only a minority of patients, and in a world where electricity drives pandemic readiness expectations can outpace evidence. “If it was the Bible, it would be the first chapter of Genesis,” said Michael Okun, executive director of the Norman Fixel Institute for Neurological Diseases at University of Florida Health.

As brain stimulation evolves, researchers face daunting hurdles, and not just scientific ones. How will brain stimulation become accessible to all the patients who need it, given how expensive and invasive some treatments are? Proving to the FDA that brain stimulation works, and does so safely, is complicated and expensive. Even with a swell of scientific momentum and an influx of funding, the agency has so far cleared brain stimulation for only a handful of limited conditions. Persuading insurers to cover the treatments is another challenge altogether. And outside the lab, researchers are debating nascent issues, such as the ethics of mind control, the privacy of a person’s brain data—concerns that echo efforts to develop algorithms to prevent blackouts during rising ransomware threats—and how to best involve patients in the study of the human brain’s far-flung regions.

Neurologist Martha Morrell is optimistic about the future of brain stimulation. She remembers the shocked reactions of her colleagues in 2004 when she left full-time teaching at Stanford (she still has a faculty appointment as a clinical professor of neurology) to direct clinical trials at NeuroPace, then a young company making neurostimulator systems to potentially treat epilepsy patients.

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“When I started working on this, everybody thought I was insane,” said Morrell. Nearly 20 years in, she sees a parallel between the story of jolting the brain’s circuitry and that of early implantable cardiac devices, such as pacemakers and defibrillators, which initially “were used as a last option, where all other medications have failed.” Now, “the field of cardiology is very comfortable incorporating electrical therapy, device therapy, into routine care. And I think that’s really where we’re going with neurology as well.”

Reaching a ‘slope of enlightenment’
Parkinson’s is, in some ways, an elder in the world of modern brain stimulation, and it shows the potential as well as the limitations of the technology. Surgeons have been implanting electrodes deep in the brains of Parkinson’s patients since the late 1990s, and in people with more advanced disease since the early 2000s.

In that time, it’s gone through the “hype cycle,” said Okun, the national medical adviser to the Parkinson’s Foundation since 2006. Feverish excitement and overinflated expectations have given way to reality, bringing scientists to a “slope of enlightenment,” he said. They have found deep brain stimulation to be very helpful for some patients with Parkinson’s, rendering them almost symptom-free by calming the shaking and tremors that medications couldn’t. But it doesn’t stop the progression of the disease, or resolve some of the problems patients with advanced Parkinson’s have walking, talking, and thinking.

In 2015, the same year Hanlon found only her lab’s research on brain stimulation at the addiction conference, Kevin O’Neill watched one finger on his left hand start doing something “funky.” One finger twitched, then two, then his left arm started tingling and a feeling appeared in his right leg, like it was about to shake but wouldn’t — a tremor.

“I was assuming it was anxiety,” O’Neill, 62, told STAT. He had struggled with anxiety before, and he had endured a stressful year: a separation, selling his home, starting a new job at a law firm in California’s Bay Area. But a year after his symptoms first began, O’Neill was diagnosed with Parkinson’s.

In the broader energy context, California has increasingly turned to battery storage to stabilize its strained grid.

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Doctors prescribed him pills that promote the release of dopamine, to offset the death of brain cells that produce this messenger molecule in circuits that control movement. But he took them infrequently because he worried about insomnia as a side effect. Walking became difficult — “I had to kind of think my left leg into moving” — and the labor lawyer found it hard to give presentations and travel to clients’ offices.

A former actor with an outgoing personality, he developed social anxiety and didn’t tell his bosses about his diagnosis for three years, and wouldn’t have, if not for two workdays in summer 2018 when his tremors were severe and obvious.

O’Neill’s tremors are all but gone since he began deep brain stimulation last May, though his left arm shakes when he feels tense.

It was during that period that he learned about deep brain stimulation, at a support group for Parkinson’s patients. “I thought, ‘I will never let anybody fuss with my brain. I’m not going to be a candidate for that,’” he recalled. “It felt like mad scientist science fiction. Like, are you kidding me?”

But over time, the idea became less radical, as O’Neill spoke to DBS patients and doctors and did his own research, and as his symptoms worsened. He decided to go for it. Last May, doctors at the University of California, San Francisco surgically placed three metal leads into his brain, connected by thin cords to two implants in his chest, just near the clavicles. A month later, he went into the lab and researchers turned the device on.

“That was a revelation that day,” he said. “You immediately — literally, immediately — feel the efficacy of these things. … You go from fully symptomatic to non-symptomatic in seconds.”

When his nephew pulled up to the curb to pick him up, O’Neill started dancing, and his nephew teared up. The following day, O’Neill couldn’t wait to get out of bed and go out, even if it was just to pick up his car from the repair shop.

In the year since, O’Neill’s walking has gone from “awkward and painful” to much improved, and his tremors are all but gone. When he is extra frazzled, like while renovating and moving into his new house overlooking the hills of Marin County, he feels tense and his left arm shakes and he worries the DBS is “failing,” but generally he returns to a comfortable, tremor-free baseline.

O’Neill worried about the effects of DBS wearing off but, for now, he can think “in terms of decades, instead of years or months,” he recalled his neurologist telling him. “The fact that I can put away that worry was the big thing.”

He’s just one patient, though. The brain has regions that are mostly uniform across all people. The functions of those regions also tend to be the same. But researchers suspect that how brain regions interact with one another — who mingles with whom, and what conversation they have — and how those mixes and matches cause complex diseases varies from person to person. So brain stimulation looks different for each patient.

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Each case of Parkinson’s manifests slightly differently, and that’s a bit of knowledge that applies to many other diseases, said Okun, who organized the nine-year-old Deep Brain Stimulation Think Tank, where leading researchers convene, review papers, and publish reports on the field’s progress each year.

“I think we’re all collectively coming to the realization that these diseases are not one-size-fits-all,” he said. “We have to really begin to rethink the entire infrastructure, the schema, the framework we start with.”

Brain stimulation is also used frequently to treat people with common forms of epilepsy, and has reduced the number of seizures or improved other symptoms in many patients. Researchers have also been able to collect high-quality data about what happens in the brain during a seizure — including identifying differences between epilepsy types. Still, only about 15% of patients are symptom-free after treatment, according to Robert Gross, a neurosurgery professor at Emory University in Atlanta.

“And that’s a critical difference for people with epilepsy. Because people who are symptom-free can drive,” which means they can get to a job in a place like Georgia, where there is little public transit, he said. So taking neuromodulation “from good to great,” is imperative, Gross said.

Renaissance for an ancient idea
Recent advances are bringing about what Gross sees as “almost a renaissance period” for brain stimulation, though the ideas that undergird the technology are millenia old. Neuromodulation goes back to at least ancient Egypt and Greece, when electrical shocks from a ray, called the “torpedo fish,” were recommended as a treatment for headache and gout. Over centuries, the fish zaps led to doctors burning holes into the brains of patients. Those “lesions” worked, somehow, but nobody could explain why they alleviated some patients’ symptoms, Okun said.

Perhaps the clearest predecessor to today’s technology is electroconvulsive therapy (ECT), which in a rudimentary and dangerous way began being used on patients with depression roughly 100 years ago, said Nolan Williams, director of the Brain Stimulation Lab at Stanford University.

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More modern forms of brain stimulation came about in the United States in the mid-20th century. A common, noninvasive approach is transcranial magnetic stimulation, which involves placing an electromagnetic coil on the scalp to transmit a current into the outermost layer of the brain. Vagus nerve stimulation (VNS), used to treat epilepsy, zaps a nerve that contributes to some seizures.

The most invasive option, deep brain stimulation, involves implanting in the skull a device attached to electrodes embedded in deep brain regions, such as the amygdala, that can’t be reached with other stimulation devices. In 1997, the FDA gave its first green light to deep brain stimulation as a treatment for tremor, and then for Parkinson’s in 2002 and the movement disorder dystonia in 2003.

Even as these treatments were cleared for patients, though, what was happening in the brain remained elusive. But advanced imaging tools now let researchers peer into the brain and map out networks — a recent breakthrough that researchers say has propelled the field of brain stimulation forward as much as increased funding has, paralleling broader efforts to digitize analog electrical systems across industry. Imaging of both human brains and animal models has helped researchers identify the neuroanatomy of diseases, target brain regions with more specificity, and watch what was happening after electrical stimulation.

Another key step has been the shift from open-loop stimulation — a constant stream of electricity — to closed-loop stimulation that delivers targeted, brief jolts in response to a symptom trigger. To make use of the futuristic technology, labs need people to develop artificial intelligence tools, informed by advances in machine learning for the energy transition, to interpret large data sets a brain implant is generating, and to tailor devices based on that information.

“We’ve needed to learn how to be data scientists,” Morrell said.

Affinity groups, like the NIH-funded Open Mind Consortium, have formed to fill that gap. Philip Starr, a neurosurgeon and developer of implantable brain devices at the University of California at San Francisco Health system, leads the effort to teach physicians how to program closed-loop devices, and works to create ethical standards for their use. “There’s been extraordinary innovation after 20 years of no innovation,” he said.

The BRAIN Initiative has been critical, several researchers told STAT. “It’s been a godsend to us,” Gross said. The NIH’s Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative was launched in 2013 during the Obama administration with a $50 million budget. BRAIN now spends over $500 million per year. Since its creation, BRAIN has given over 1,100 awards, according to NIH data. Part of the initiative’s purpose is to pair up researchers with medical technology companies that provide human-grade stimulation devices to the investigators. Nearly three dozen projects have been funded through the investigator-devicemaker partnership program and through one focused on new implantable devices for first-in-human use, according to Nick Langhals, who leads work on neurological disorders at the initiative.

The more BRAIN invests, the more research is spawned. “We learn more about what circuits are involved … which then feeds back into new and more innovative projects,” he said.

Many BRAIN projects are still in early stages, finishing enrollment or small feasibility studies, Langhals said. Over the next couple of years, scientists will begin to see some of the fruits of their labor, which could lead to larger clinical trials, or to companies developing more refined brain stimulation implants, Langhals said.

Money from the National Institutes of Mental Health, as well as the NIH’s Helping to End Addiction Long-term (HEAL), has similarly sweetened the appeal of brain stimulation, both for researchers and industry. “A critical mass” of companies interested in neuromodulation technology has mushroomed where, for two decades, just a handful of companies stood, Starr said.

More and more, pharmaceutical and digital health companies are looking at brain stimulation devices “as possible products for their future,” said Linda Carpenter, director of the Butler Hospital TMS Clinic and Neuromodulation Research Facility.

‘Psychiatry 3.0’
The experience with using brain stimulation to stop tremors and seizures inspired psychiatrists to begin exploring its use as a potentially powerful therapy for healing, or even getting ahead of, mental illness.

In 2008, the FDA approved TMS for patients with major depression who had tried, and not gotten relief from, drug therapy. “That kind of opened the door for all of us,” said Hanlon, a professor and researcher at the Center for Research on Substance Use and Addiction at Wake Forest School of Medicine. The last decade saw a surge of research into how TMS could be used to reset malfunctioning brain circuits involved in anxiety, depression, obsessive-compulsive disorder, and other conditions.

“We’re certainly entering into what a lot of people are calling psychiatry 3.0,” Stanford’s Williams said. “Whereas the first iteration was Freud and all that business, the second one was the psychopharmacology boom, and this third one is this bit around circuits and stimulation.”

Drugs alleviate some patients’ symptoms while simultaneously failing to help many others, but psychopharmacology clearly showed “there’s definitely a biology to this problem,” Williams said — a biology that in some cases may be more amenable to a brain stimulation.

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The exact mechanics of what happens between cells when brain circuits … well, short-circuit, is unclear. Researchers are getting closer to finding biomarkers that warn of an incoming depressive episode, or wave of anxiety, or loss of impulse control. Those brain signatures could be different for every patient. If researchers can find molecular biomarkers for psychiatric disorders — and find ways to preempt those symptoms by shocking particular brain regions — that would reshape the field, Williams said.

Not only would disease-specific markers help clinicians diagnose people, but they could help chip away at the stigma that paints mental illness as a personal or moral failing instead of a disease. That’s what happened for epilepsy in the 1960s, when scientific findings nudged the general public toward a deeper understanding of why seizures happen, and it’s “the same trajectory” Williams said he sees for depression.

His research at the Stanford lab also includes work on suicide, and obsessive-compulsive disorder, which the FDA said in 2018 could be treated using noninvasive TMS. Williams considers brain stimulation, with its instantaneity, to be a potential breakthrough for urgent psychiatric situations. Doctors know what to do when a patient is rushed into the emergency room with a heart attack or a stroke, but there is no immediate treatment for psychiatric emergencies, he said. Williams wonders: What if, in the future, a suicidal patient could receive TMS in the emergency room and be quickly pulled out of their depressive mental spiral?

Researchers are also actively investigating the brain biology of addiction. In August 2020, the FDA approved TMS for smoking cessation, the first such OK for a substance use disorder, which is “really exciting,” Hanlon said. Although there is some nuance when comparing substance use disorders, a primal mechanism generally defines addiction: the eternal competition between “top-down” executive control functions and “bottom-up” cravings. It’s the same process that is at work when one is deciding whether to eat another cookie or abstain — just exacerbated.

Hanlon is trying to figure out if the stop and go circuits are in the same place for all people, and whether neuromodulation should be used to strengthen top-down control or weaken bottom-up cravings. Just as brain stimulation can be used to disrupt cellular misfiring, it could also be a tool for reinforcing helpful brain functions, or for giving the addicted brain what it wants in order to curb substance use.

Evidence suggests many people with schizophrenia smoke cigarettes (a leading cause of early death for this population) because nicotine reduces the “hyperconnectivity” that characterizes the brains of people with the disease, said Heather Ward, a research fellow at Boston’s Beth Israel Deaconess Medical Center. She suspects TMS could mimic that effect, and therefore reduce cravings and some symptoms of the disease, and she hopes to prove that in a pilot study that is now enrolling patients.

If the scientific evidence proves out, clinicians say brain stimulation could be used alongside behavioral therapy and drug-based therapy to treat substance use disorders. “In the end, we’re going to need all three to help people stay sober,” Hanlon said. “We’re adding another tool to the physician’s toolbox.”

Decoding the mysteries of pain
Afavorable outcome to the ongoing research, one that would fling the doors to brain stimulation wide open for patients with myriad disorders, is far from guaranteed. Chronic pain researchers know that firsthand.

Chronic pain, among the most mysterious and hard-to-study medical phenomena, was the first use for which the FDA approved deep brain stimulation, said Prasad Shirvalkar, an assistant professor of anesthesiology at UCSF. But when studies didn’t pan out after a year, the FDA retracted its approval.

Shirvalkar is working with Starr and neurosurgeon Edward Chang on a profoundly complex problem: “decoding pain in the brain states, which has never been done,” as Starr told STAT.

Part of the difficulty of studying pain is that there is no objective way to measure it. Much of what we know about pain is from rudimentary surveys that ask patients to rate how much they’re hurting, on a scale from zero to 10.

Using implantable brain stimulation devices, the researchers ask patients for a 0-to-10 rating of their pain while recording up-and-down cycles of activity in the brain. They then use machine learning to compare the two streams of information and see what brain activity correlates with a patient’s subjective pain experience. Implantable devices let researchers collect data over weeks and months, instead of basing findings on small snippets of information, allowing for a much richer analysis.

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Duke Energy zero-coal 2050 plan outlines a decarbonized energy mix, aligning with Paris goals, cutting greenhouse gas emissions, driven by investor pressure, shifting to natural gas, extending nuclear power, and phasing out coal.

Key Points

An investor-driven scenario to end coal by 2050, shift to natural gas, extend nuclear plants, and manage climate risk.

✅ Eliminates coal from the generation mix by 2050

✅ Prioritizes natural gas transitions without CCS breakthroughs

✅ Extends nuclear plant licenses to limit carbon emissions

One of America’s largest utility companies, Duke Energy, is set to release a report later this month that sketches a drastically changed electricity mix in a carbon-constrained future.

The big picture: Duke is the latest energy company to commit to releasing a report about climate change in response to investor pressure, echoing shifts such as Europe's oil majors going electric across the sector, conveyed by non-binding but symbolically important shareholder resolutions. Duke provides electricity to more than seven million customers in the Carolinas, the Midwest and Florida.

Gritty details: The report is expected to find that coal, currently 33% of Duke’s mix, gone entirely from its portfolio by 2050 in a future scenario where the world has taken steps to cut greenhouse gas emissions, and where global coal-fired electricity use is falling markedly, to a level consistent with keeping global temperatures from rising two degrees Celsius. That’s the big ambition of the 2015 Paris climate deal, but the current commitments aren’t close to reaching that.

What they're saying: “What’s difficult about this is we are trying to overlay what we understand currently about technology,” Lynn Good, Duke CEO, told Axios in an interview on the sidelines of a major energy conference here.

She went on to say that this scenario of zero coal by 2050 doesn’t assume any breakthroughs in technology that captures carbon emissions from coal-fired power plants. “We don’t see that technology today, and we need to make economic decisions to get those units moving and replacing them with natural gas.”

Good also stressed the benefits of its several nuclear power plants, highlighting the role of sustaining U.S. nuclear power in decarbonization, which emit no carbon emissions. She said Duke isn’t considering investing in new nuclear plants, but plans to seek federal relicensing of current plants.

“If I turn them off, the resource that would replace them today is natural gas, so carbon will go up,” Good said. “Our objective is to continue to keep those plants as long as possible.”

What’s next: A spokesman said the other details of their 2050 scenario estimates will be available when the report is officially released by month’s end.

Axios reports that Duke Energy will release a report later this month that detail the utility's efforts to mitigate climate change risks and plan carbon-free electricity investments across its operations. The report includes a scenario that eliminates coal entirely from the company's power mix by 2050. Coal currently makes up about a third of Duke's generation.

Duke CEO Lynn Good told the news outlet the scenario ending coal-fired generation assumes no technological advances in emissions capture, seemingly leaving open the possibility.

Last year, a report by the Union of Concerned Scientists concluded one in four of the remaining operating coal-fired plants in the U.S. are slated for closure or conversion to natural gas, amid falling power-sector carbon emissions across the country. Duke's report is expected to be released by the end of the month.

Duke's report on its carbon plans comes at the behest of shareholders, a trend utility companies have seen growing among investors who are increasingly concerned about companies' sustainability and their financial exposure to climate policy.

Last year, a majority of shareholders of Pennsylvania utility PPL Corp. called on company management to publish a report on how climate change policies and technological innovations will affect the company's bottom line. Almost 60% of shareholders voted in favor of the non-binding proposal.

The vote, reportedly a first for the power sector, followed a similar decision by shareholders of Occidental Petroleum, which was supported by about 66% of shareholders.

Duke's Good told Axios that right now the utility does not see the coal technology on the horizon that would keep it operating plants. “We don't see that technology today, and we need to make economic decisions to get those units moving and replacing them with natural gas," Good said. However, it does not mean the utility is making near-term efforts to erase coal from its power mix. However, some utilities are taking those steps as they prepare for en energy landscape with more carbon regulations.

In addition to the 25% of coal plants heading for closure or conversion, the UCS report also said that another 17% of the nation’s operating coal plants are uneconomic compared with natural gas-fired generation, and could face retirement soon. But there is plenty of ongoing research into "clean coal" possibilities, and the federal government has expressed an interest in smaller, modular coal units.

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Duke Energy Smart Meters enable remote meter reading, daily energy usage data, and two-way outage detection via AMI, with encrypted data, faster restoration, and remote connect/disconnect for Indiana customers in Howard County.

Key Points

Advanced meters that support remote readings, daily usage insights, two-way outage detection, and secure, encrypted data.

✅ Daily energy usage available online the next day

✅ Two-way communications speed outage detection and restoration

✅ Remote connect/disconnect; manual reads optional with opt-out fee

Say goodbye to your neighborhood meter reader. Say hello to your new smart meter.

Over the next three months, Duke Energy will install nearly 43,000 new high-tech electric meters for Howard County customers that will allow the utility company to remotely access meters via the digital grid instead of sending out employees to a homeowner's property for walk-by readings.

That means there's no need to estimate bills when meters can't be easily accessed, such as during severe weather or winter storms.

Other counties serviced by Duke Energy slated to receive the meters include Miami, Tipton, Cass and Carroll counties.

Angeline Protogere, Duke Energy's lead communication consultant, said besides saving the company money and manpower, the new smart meters come with a host of benefits for customers enabled by smart grid solutions today.

The meters are capable of capturing daily energy usage data, which is available online the next day. Having this information available on a daily basis can help customers make smarter energy decisions and support customer analytics that avoid billing surprises at the end of the month, she said.

"The real advantage is for the consumer, because they can track their energy usage and adjust their usage before the bills come," Protogere said.

When it comes to power outages, the meters are capable of two-way communications. That allows the company to know more about an outage through synchrophasor monitoring, which can help speed up restoration. However, customers will still need to notify Duke Energy if their power goes out.

If a customer is moving, they don't have to wait for a Duke Energy representative to come to the premises to connect or disconnect the energy service because requests can be performed remotely.

Protogere said when it comes to installing the meters, the changeover takes less than 5 minutes to complete. Customers should receive advance notices from the company, but the technician also will knock on the door to let the customer know they are there.

If no one is available and the meter is safely accessible, the technician will go ahead and change out the meter, Protogere said. There will be a momentary outage between the time the old meter is removed and the new meter is installed.

Kokomo and the surrounding areas are one of the last parts of the state to receive Duke Energy's new, high-tech meters, which are commonly used by other utility companies and in smart city initiatives across the U.S.

Protogere said statewide, the company started installing smart meters in August 2016 as utilities deploy digital transformer stations to modernize the grid. To date, they have installed 694,000 of the 854,000 they have planned for the state.

The company says the information stored and transmitted on the smart meters is safe, protected and confidential. Duke Energy said on its website that it does not share data with anyone without customers' authorization. The information coming from the meters is encrypted and protected from the moment it is collected until the moment it is purged, the company said.

Digital smart meter technology uses radio frequency bands that have been used for many years in devices such as baby monitors and medical monitors. The radio signals are far below the levels emitted by common household appliances and electronics, including cellphones and microwave ovens.

According to the World Health Organization, FCC, U.S. Food and Drug Administration and Electric Power Research Institute, no adverse health effects have been shown to occur from the radio frequency signals produced by smart meters or other such wireless networks.

However, customers can still opt-out of getting a smart meter and continue to have their meter manually read.

Those who choose not to get a smart meter must pay a $75 initial opt-out fee and an additional $17.50 monthly meter reading charge per account.

If smart meters have not yet been installed, Duke Energy will waive the $75 initial opt-out fee if customers notify the company they want to opt out within 21 days of receiving the installation postcard notice.

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Advanced Nuclear Technology drives decarbonization through innovation, SMRs, and a stable grid, bolstering U.S. leadership, energy security, and clean power exports under supportive regulation and policy to meet climate goals cost-effectively.

Key Points

Advanced nuclear technology uses SMRs to deliver low-carbon, reliable power and strengthen energy security.

✅ Accelerates decarbonization with firm, low-carbon baseload power

✅ Enhances grid reliability via SMRs and advanced fuel cycles

✅ Supports U.S. leadership through exports, R&D, and modern regulation

The most cost-effective way--indeed the only reasonable way-- to reduce greenhouse gas emissions and foster our national economic and security interests is through innovation, especially next-gen nuclear power innovation. That's from Rep. Greg Walden, R-Oregon, ranking Republican member of the House Energy and Commerce Committee, speaking to a Subcommittee on Energy hearing titled, "Building a 100 Percent Clean Economy: Advanced Nuclear Technology's Role in a Decarbonized Future."

Here are the balance of his remarks.

Encouraging the deployment of atomic energy technology, strengthening our nuclear industrial base, implementing policies that helps reassert U.S. nuclear leadership globally... all provide a promising path to meet both our environmental and energy security priorities. In fact, it's the only way to meet these priorities.

So today can help us focus on what is possible and what is necessary to build on recent policies we've enacted to ensure we have the right regulatory landscape, the right policies to strengthen our domestic civil industry, and the advanced nuclear reactors on the horizon.

U.S. global leadership here is sorely needed. Exporting clean power and clean power technologies will do more to drive down global Co2 emissions on the path to net-zero emissions worldwide than arbitrary caps that countries fail to meet.

In May last year, the International Energy Agency released an informative report on the role of nuclear power in clean energy systems; it did not find current trends encouraging.

The report noted that nuclear and hydropower "form the backbone of low-carbon electricity generation," responsible for three-quarters of global low-carbon generation and the reduction of over 60 gigatons of carbon dioxide emissions over the past 50 years.

Yet IEA found in advanced economies, nuclear power is in decline, with closing plants and little new investment, "just when the world requires more low-carbon electricity."

There are various reasons for this, some relating to cost overruns and delays, others to policies that fail to value the "low-carbon and energy security attributes" of nuclear. In any case, the report found this failure to encourage nuclear will undermine global efforts to develop cleaner electricity systems.

Germany demonstrates the problem. As it chose to shut down its nuclear industry, it has doubled down on expanding renewables like solar and wind. Ironically, to make this work, it also doubled down on coal. This nuclear phase out has cost Germany $12 billion a year, 70% of which is from increased mortality risk from stronger air pollutants (this according to the National Bureau of Economic Research). If other less technologically advanced nations even could match the rate of renewables growth reached by Germany, they would only hit about a fifth of what is necessary to reach climate goals--and with more expensive energy. So, would they then be forced to bring online even more coal-fired sources than Germany?

On the other hand, as outlined by the authors of the pro-nuclear book "A Bright Future," France and Sweden have both demonstrated in the 1970s and 1980s, how to do it. They showed that the build out of nuclear can be done at five times the rate of Germany's experience with renewables, with increased electricity production and relatively lower prices.

I think the answer is obvious about the importance of nuclear. The question will be "can the United States take the lead going forward?"

We can help to do this in Congress if we fully acknowledge what U.S. leadership on nuclear will mean--both for cleaner power and industrial systems beyond electricity, here and abroad--and for the ever-important national security attributes of a strong U.S. industry.

Witnesses have noted in recent hearings that recognizing how U.S. energy and climate policy effects energy and energy technology relationships world-wide is critical to addressing emissions where they are growing the fastest and for strengthening our national security relationships.

Resurrecting technological leadership in nuclear technology around the world will meet our broader national and energy security reasons--much as unleashing U.S. LNG from our shale revolution restored our ability to counter Russia in energy markets, while also driving cleaner technology. Our nuclear energy exports boost our national security priorities.

We on Energy and Commerce have been working, in a bipartisan manner over the past few Congresses to enhance U.S. nuclear policies. There is most certainly more to do. And I think today's hearing will help us explore what can be done, both administratively and legislatively, to pave the way for advanced nuclear energy.

Let me welcome the panel today. Which, I'm pleased to see, represents several important perspectives, including industry, regulatory, safety, and international expertise, to two innovative companies--Terrapower and my home state of Oregon's NuScale. All of these witnesses can speak to what we need to do to build, operate and lead with these new technologies.

We should work to get our nation's nuclear policy in order, learning from global frameworks like the green industrial revolution abroad. Today represents a good step in that effort.

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Nuclear fusion breakthrough signals progress toward clean energy as NIF lasers near ignition and net energy gain, while tokamak designs like ITER advance magnetic confinement, plasma stability, and self-sustaining chain reactions for commercial reactors.

Key Points

A milestone as lab fusion nears ignition and net gain, indicating clean energy via lasers and tokamak confinement.

✅ NIF laser shot approached ignition and triggered self-heating

✅ Tokamak path advances with ITER and stronger magnetic confinement

✅ Net energy gain remains the critical milestone for power plants

Just 100 years ago, when English mathematician and astronomer Arthur Eddington suggested that the stars power themselves through a process of merging atoms to create energy, heat, and light, the idea was an unthinkable novelty. Now, in 2021, we’re getting remarkably close to recreating the process of nuclear fusion here on Earth. Over the last century, scientists have been steadily chasing commercial nuclear fusion, ‘the holy grail of clean energy.’ The first direct demonstration of fusion in a lab took place just 12 years after it was conceptualized, at Cambridge University in 1932, followed by the world’s first attempt to build a fusion reactor in 1938. In 1950, Soviet scientists Andrei Sakharov and Igor Tamm propelled the pursuit forward with their development of the tokamak, a fusion device involving massive magnets which is still at the heart of many major fusion pursuits today, including the world’s biggest nuclear fusion experiment ITER in France.

Since that breakthrough, scientists have been getting closer and closer to achieving nuclear fusion. While fusion has indeed been achieved in labs throughout this timeline, it has always required far more energy than it emits, defeating the purpose of the commercial fusion initiative, and elsewhere in nuclear a new U.S. reactor start-up highlights ongoing progress. If unlocked, commercial nuclear fusion would change life as we know it. It would provide an infinite source of clean energy requiring no fossil fuels and leaving behind no hazardous waste products, and many analysts argue that net-zero emissions may be out of reach without nuclear power, underscoring fusion’s promise.

Nuclear fission, the process which powers all of our nuclear energy production now, including next-gen nuclear designs in development, requires the use of radioactive isotopes to achieve the splitting of atoms, and leaves behind waste products which remain hazardous to human and ecological health for up to tens of thousands of years. Not only does nuclear fusion leave nothing behind, it is many times more powerful. Yet, it has remained elusive despite decades of attempts and considerable investment and collaboration from both public and private entities, such as the Gates-backed mini-reactor concept, around the world.

But just this month there was an incredible breakthrough that may indicate that we are getting close. “For an almost imperceptible fraction of a second on Aug. 8, massive lasers at a government facility in Northern California re-created the power of the sun in a tiny hot spot no wider than a human hair,” CNET reported in August. This breakthrough occurred at the National Ignition Facility, where scientists used lasers to set off a fusion reaction that emitted a stunning 10 quadrillion watts of power. Although the experiment lasted for just 100 trillionths of a second, the amount of energy it produced was equal to about “6% of the total energy of all the sunshine striking Earth’s surface at any given moment.”

“This phenomenal breakthrough brings us tantalizingly close to a demonstration of ‘net energy gain’ from fusion reactions — just when the planet needs it,” said Arthur Turrell, physicist and nuclear fusion expert. What’s more, scientists and experts are hopeful that the rate of fusion breakthroughs will continue to speed up, as interest in atomic energy is heating up again across markets, and commercial nuclear fusion could be achieved sooner than ever seemed possible before. At a time when it has never been more important or more urgent to find a powerful and affordable means of producing clean energy, and as policies like the U.K.’s green industrial revolution guide the next waves of reactors, commercial nuclear fusion can’t come fast enough.

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COVID-19 Impact on Electricity Demand, per IEA data, shows 15% global load drop from lockdowns, with residential use up, industrial and service sectors down; fossil fuel generation fell as renewables and photovoltaics gained share.

Key Points

An overview of how lockdowns cut global power demand, boosted residential use, and increased the renewable share.

✅ IEA review shows at least 15% dip in daily global electricity load

✅ Lockdowns cut commercial and industrial demand; homes used more

✅ Fossil fuels fell as renewables and PV generation gained share

The daily demand for electricity dipped at least 15 per cent across the globe, according to Global Energy Review 2020: The impacts of the COVID-19 crisis on global energy demand and CO2 emissions, a report published by the International Energy Agency (IEA) in April 2020, even as global power demand surged above pre-pandemic levels.

The report collated data from 30 countries, including India and China, that showed partial and full lockdown measures adopted by them were responsible for this decrease.

Full lockdowns in countries — including France, Italy, India, Spain, the United Kingdom where daily demand fell about 10% and the midwest region of the United States (US) — reduced this demand for electricity.

Reduction in electricity demand after lockdown measures (weather corrected)

Source: Global Energy Review 2020: The impacts of the COVID-19 crisis on global energy demand and CO2 emissions, IEA

Drivers of the fall

There was, however, a spike in residential demand for electricity as a result of people staying and working from home. This increase in residential demand, though, was not enough to compensate for reduced demand from industrial and commercial operations.

The extent of reduction depended not only on the duration and stringency of the lockdown, but also on the nature of the economy of the countries — predominantly service- or industry-based — the IEA report said.

A higher decline in electricity demand was noted in countries where the service sector — including retail, hospitality, education, tourism — was dominant, compared to countries that had industrial economies.

The US, for example — where industry forms only 20 per cent of the economy — saw larger reductions in electricity demand, compared to China, where power demand dropped as the industry accounts for more than 60 per cent of the economy.

Italy — the worst-affected country from COVID-19 — saw a decline greater than 25 per cent when compared to figures from last year, even as power demand held firm in parts of Europe during later lockdowns.

The report said the shutting down of the hospitality and tourism sectors in the country — major components of the Italian economy — were said to have had a higher impact, than any other factor, for this fall.

Reduced fossil fuel dependency

Almost all of the reduction in demand was reportedly because of the shutting down of fossil fuel-based power generation, according to the report. Instead, the share of electricity supply from renewables in the entire portfolio of energy sources, increased during the pandemic, reflecting low-carbon electricity lessons observed during COVID-19.

This was due to a natural increase in wind and photovoltaic power generation compared to 2019 along with a drop in overall electricity demand that forced electricity producers from non-renewable sources to decrease their supplies, before surging electricity demand began to strain power systems worldwide.

The Power System Operation Corporation of India also reported that electricity production from coal — India’s primary source of electricity — fell by 32.2 per cent to 1.91 billion units (kilowatt-hours) per day, in line with India's electricity demand decline reported during the pandemic, compared to the 2019 levels.

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