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Stockholders' equity (Reclassifications out of AOCI) (Details) - USD ($)
$ in Millions
3 Months Ended 12 Months Ended
Dec. 31, 2018
Sep. 30, 2018
Jun. 30, 2018
Mar. 31, 2018
Dec. 31, 2017
Sep. 30, 2017
Jun. 30, 2017
Mar. 31, 2017
Dec. 31, 2018
Dec. 31, 2017
Dec. 31, 2016
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Interest and other income, net                 $ 674 $ 928 $ 629
Interest expense, net                 (1,392) (1,304) (1,260)
Income before income taxes                 9,545 9,597 9,163
Provision for income taxes                 (1,151) (7,618) (1,441)
Net income $ 1,928 $ 1,859 $ 2,296 $ 2,311 $ (4,264) $ 2,021 $ 2,151 $ 2,071 8,394 1,979 7,722
Product sales [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Revenues $ 6,001 $ 5,510 $ 5,679 $ 5,343 $ 5,569 $ 5,453 $ 5,574 $ 5,199 22,533 21,795 21,892
Reclassification out of AOCI [Member] | Cash flow hedges [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Income before income taxes                 (262) 638 (139)
Provision for income taxes                 55 (226) 46
Net income                 (207) 412 (93)
Reclassification out of AOCI [Member] | Available-for-sale securities [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Interest and other income, net                 (365) (41) (61)
Provision for income taxes                 3 (8) 11
Net income                 (362) (49) (50)
Reclassification out of AOCI [Member] | Cash flow hedge [Member] | Cash flow hedges [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Income before income taxes                 (262) 638 (139)
Reclassification out of AOCI [Member] | Foreign currency contract [Member] | Product sales [Member] | Cash flow hedges [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Revenues                 (21)    
Reclassification out of AOCI [Member] | Foreign currency contract [Member] | Cash flow hedge [Member] | Product sales [Member] | Cash flow hedges [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Revenues                 (21) 65 308
Reclassification out of AOCI [Member] | Cross-currency swap contract [Member] | Cash flow hedges [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Interest and other income, net                 (241)    
Reclassification out of AOCI [Member] | Cross-currency swap contract [Member] | Cash flow hedge [Member] | Cash flow hedges [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Interest and other income, net                 (241) 574 (446)
Reclassification out of AOCI [Member] | Forward interest rate contract [Member] | Cash flow hedge [Member] | Cash flow hedges [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Interest expense, net                 $ 0 $ (1) $ (1)