Taxes (Details 3) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Income Tax Disclosure [Abstract]
Effective Tax Rate Reconciliation, Excess Tax Benefits	$ (13,836)	$ (35,171)	$ 0
Effect of Biotix contingent consideration gain	(4,394)	0	0
Income Tax Expense (Benefit), at Federal Statutory Income Tax Rate	136,890	200,978	176,467
State and Local Income Taxes	2,787	376	3,064
Provisional one-time charge on US tax reform	3,597	71,982	0
Foreign Income Tax Rate Differential	12,710	(43,691)	(65,917)
Other Adjustments	1,493	3,776	6,209
Provision for taxes	$ 139,247	$ 198,250	$ 119,823
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent		35.00%	35.00%