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Fair value measurement (Fair Value of Financial Assets and Liabilities on Recurring Basis) (Details) - USD ($)
$ in Millions
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
Dec. 31, 2014
Assets:        
Total available-for-sale investments $ 41,318 $ 37,781    
Recurring [Member]        
Derivative Assets:        
Total assets 41,604 38,025    
Derivative Liabilities:        
Contingent consideration obligations in connection with business combinations 69 179    
Total liabilities 554 713    
Recurring [Member] | Foreign currency contracts [Member]        
Derivative Assets:        
Foreign currency contracts 6 203    
Derivative Liabilities:        
Foreign currency contracts 204 4    
Recurring [Member] | Cross-currency swap contracts [Member]        
Derivative Assets:        
Foreign currency contracts 270      
Derivative Liabilities:        
Foreign currency contracts 220 523    
Recurring [Member] | Interest rate swap contracts [Member]        
Derivative Assets:        
Interest rate swap contracts 10 41    
Derivative Liabilities:        
Interest rate swap contracts 61 7    
Recurring [Member] | U.S. Treasury securities [Member]        
Assets:        
Total available-for-sale investments 8,242 6,614    
Recurring [Member] | Other government-related debt securities - U.S. [Member]        
Assets:        
Total available-for-sale investments 223 299    
Recurring [Member] | Other government-related debt securities - Foreign and other [Member]        
Assets:        
Total available-for-sale investments 2,422 1,759    
Recurring [Member] | Corporate debt securities - Financial [Member]        
Assets:        
Total available-for-sale investments 10,072 8,460    
Recurring [Member] | Corporate debt securities - Industrial [Member]        
Assets:        
Total available-for-sale investments 9,670 8,789    
Recurring [Member] | Corporate debt securities - Other [Member]        
Assets:        
Total available-for-sale investments 1,390 1,077    
Recurring [Member] | Residential mortgage-backed securities [Member]        
Assets:        
Total available-for-sale investments 2,168 1,940    
Recurring [Member] | Other mortgage- and asset-backed securities [Member]        
Assets:        
Total available-for-sale investments 2,297 1,719    
Recurring [Member] | Money market mutual funds [Member]        
Assets:        
Total available-for-sale investments 3,245 2,782    
Recurring [Member] | Other short-term interest-bearing securities [Member]        
Assets:        
Total available-for-sale investments 1,440 4,188    
Recurring [Member] | Equity securities [Member]        
Assets:        
Total available-for-sale investments 149 154    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member]        
Derivative Assets:        
Total assets 11,636 9,550    
Derivative Liabilities:        
Contingent consideration obligations in connection with business combinations 0 0    
Total liabilities 0 0    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Foreign currency contracts [Member]        
Derivative Assets:        
Foreign currency contracts 0 0    
Derivative Liabilities:        
Foreign currency contracts 0 0    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Cross-currency swap contracts [Member]        
Derivative Assets:        
Foreign currency contracts 0      
Derivative Liabilities:        
Foreign currency contracts 0 0    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Interest rate swap contracts [Member]        
Derivative Assets:        
Interest rate swap contracts 0 0    
Derivative Liabilities:        
Interest rate swap contracts 0 0    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | U.S. Treasury securities [Member]        
Assets:        
Total available-for-sale investments 8,242 6,614    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Other government-related debt securities - U.S. [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Other government-related debt securities - Foreign and other [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Corporate debt securities - Financial [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Corporate debt securities - Industrial [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Corporate debt securities - Other [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Residential mortgage-backed securities [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Other mortgage- and asset-backed securities [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Money market mutual funds [Member]        
Assets:        
Total available-for-sale investments 3,245 2,782    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Other short-term interest-bearing securities [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Quoted prices in active markets for identical assets (Level 1) [Member] | Equity securities [Member]        
Assets:        
Total available-for-sale investments 149 154    
Recurring [Member] | Significant other observable inputs (Level 2) [Member]        
Derivative Assets:        
Total assets 29,968 28,475    
Derivative Liabilities:        
Contingent consideration obligations in connection with business combinations 0 0    
Total liabilities 485 534    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Foreign currency contracts [Member]        
Derivative Assets:        
Foreign currency contracts 6 203    
Derivative Liabilities:        
Foreign currency contracts 204 4    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Cross-currency swap contracts [Member]        
Derivative Assets:        
Foreign currency contracts 270      
Derivative Liabilities:        
Foreign currency contracts 220 523    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Interest rate swap contracts [Member]        
Derivative Assets:        
Interest rate swap contracts 10 41    
Derivative Liabilities:        
Interest rate swap contracts 61 7    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | U.S. Treasury securities [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Other government-related debt securities - U.S. [Member]        
Assets:        
Total available-for-sale investments 223 299    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Other government-related debt securities - Foreign and other [Member]        
Assets:        
Total available-for-sale investments 2,422 1,759    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Corporate debt securities - Financial [Member]        
Assets:        
Total available-for-sale investments 10,072 8,460    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Corporate debt securities - Industrial [Member]        
Assets:        
Total available-for-sale investments 9,670 8,789    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Corporate debt securities - Other [Member]        
Assets:        
Total available-for-sale investments 1,390 1,077    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Residential mortgage-backed securities [Member]        
Assets:        
Total available-for-sale investments 2,168 1,940    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Other mortgage- and asset-backed securities [Member]        
Assets:        
Total available-for-sale investments 2,297 1,719    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Money market mutual funds [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Other short-term interest-bearing securities [Member]        
Assets:        
Total available-for-sale investments 1,440 4,188    
Recurring [Member] | Significant other observable inputs (Level 2) [Member] | Equity securities [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member]        
Derivative Assets:        
Total assets   0    
Derivative Liabilities:        
Contingent consideration obligations in connection with business combinations 69 179 $ 188 $ 215
Total liabilities 69 179    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Foreign currency contracts [Member]        
Derivative Assets:        
Foreign currency contracts 0 0    
Derivative Liabilities:        
Foreign currency contracts 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Cross-currency swap contracts [Member]        
Derivative Assets:        
Foreign currency contracts 0      
Derivative Liabilities:        
Foreign currency contracts 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Interest rate swap contracts [Member]        
Derivative Assets:        
Interest rate swap contracts 0 0    
Derivative Liabilities:        
Interest rate swap contracts 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | U.S. Treasury securities [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Other government-related debt securities - U.S. [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Other government-related debt securities - Foreign and other [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Corporate debt securities - Financial [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Corporate debt securities - Industrial [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Corporate debt securities - Other [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Residential mortgage-backed securities [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Other mortgage- and asset-backed securities [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Money market mutual funds [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Other short-term interest-bearing securities [Member]        
Assets:        
Total available-for-sale investments 0 0    
Recurring [Member] | Significant unobservable inputs (Level 3) [Member] | Equity securities [Member]        
Assets:        
Total available-for-sale investments $ 0 $ 0