Quarterly financial data (unaudited) (Details) - USD ($) $ / shares in Units, $ in Millions	3 Months Ended								12 Months Ended
	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2016	Sep. 30, 2016	Jun. 30, 2016	Mar. 31, 2016	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Quarterly Financial Information Disclosure [Abstract]
Product sales	$ 5,569	$ 5,453	$ 5,574	$ 5,199	$ 5,663	$ 5,516	$ 5,474	$ 5,239	$ 21,795	$ 21,892	$ 20,944
Gross profit from product sales	4,510	4,463	4,550	4,203	4,596	4,489	4,424	4,221
Net income	$ (4,264)	$ 2,021	$ 2,151	$ 2,071	$ 1,935	$ 2,017	$ 1,870	$ 1,900	$ 1,979	$ 7,722	$ 6,939
(Loss) earnings per share:
Basic (in usd per share)	$ (5.89)	$ 2.78	$ 2.93	$ 2.81	$ 2.61	$ 2.70	$ 2.49	$ 2.52	$ 2.71	$ 10.32	$ 9.15
Diluted (in usd per share)	$ (5.89)	$ 2.76	$ 2.91	$ 2.79	$ 2.59	$ 2.68	$ 2.47	$ 2.50	$ 2.69	$ 10.24	$ 9.06