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Any idiot with a reactor can transmute elements.

Really? Someone has a reactor that transmutes lead into gold or another base metal. Got a link?

People are working on 'zero point' energy to extract usable power from quantum mechanical vacuum fluctuations. Also there are several commercially products that do 'energy harvesting' to power flea watt electronics...

How are these perpetual motion machines?

Really? Someone has a reactor that transmutes lead into gold or another base metal. Got a link?

It can be done, but it is a very expensive way to make gold. Transmuting elements has been being done deliberately since the early 1940's.

The medical industry depends heavily on synthetic radio isotopes.

The semiconductor industry used 'transmutation doped' or NTD - 'neutron transmutation doped' silicon, it's the only way to get even phosphorus distribution, as higher concentrations of phosphorus tend to segregate out in a melt.

How are these perpetual motion machines?

Zero point energy, would be an infinite source of power as the quantum fluctuations (the generation of 'virtual' particle and antiparticle pairs) are a fundamental part of the universe.

Commercial energy harvesters generate useful amounts of energy from stray radio waves, environmental vibrations, changes in temperature or pressure. In principle, a vibration energy harvester could extract energy until the whole universe is near absolute zero. Not quite infinite, but close enough!

For the reactor part: what you're looking for is called fusion and fission. Hydrogen and other elements smaller than gold (or the target element) can be fused to make that element. Fission can turn heavier elements into the target element. Tricky, and probably takes huge amounts of energy (fusion takes more energy after a while than fusion produces; same with fission, so depends on what your target is), but theoretically there isn't physical laws stopping such materials transition.

As for zero point energy, you could have current physics on your side. But--if you're one of those freepers who poo-poo 'free energy' machines to an almost violent extent--would also point out that four centuries ago the idea that particles could exist in two states simultaneously would probably have been similarly poo-pooed. Hopefully they do find out how to tap into zero point energy. An extremely long shot, but many people would have uses for having no electric bill.