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Stockholders' equity (Reclassifications out of AOCI) (Details) - USD ($)
$ in Millions
3 Months Ended
Mar. 31, 2018
Mar. 31, 2017
Reclassification out of Accumulated Other Comprehensive Income [Line Items]    
Product sales $ 5,343 $ 5,199
Interest and other income, net 231 195
Income before income taxes 2,619 2,460
Provision for income taxes (308) (389)
Net income 2,311 2,071
Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedges [Member]    
Reclassification out of Accumulated Other Comprehensive Income [Line Items]    
Income before income taxes 130 131
Provision for income taxes (28) (47)
Net income 102 84
Reclassification out of Accumulated Other Comprehensive Income [Member] | Available-for-sale securities [Member]    
Reclassification out of Accumulated Other Comprehensive Income [Line Items]    
Interest and other income, net (134) (49)
Provision for income taxes 1 0
Net income (133) (49)
Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedges [Member] | Cash flow hedges [Member]    
Reclassification out of Accumulated Other Comprehensive Income [Line Items]    
Income before income taxes 130 131
Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedges [Member] | Foreign currency contract [Member] | Cash flow hedges [Member]    
Reclassification out of Accumulated Other Comprehensive Income [Line Items]    
Product sales (34) 57
Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedges [Member] | Cross-currency swap contract [Member] | Cash flow hedges [Member]    
Reclassification out of Accumulated Other Comprehensive Income [Line Items]    
Interest and other income, net $ 164 $ 74