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Stockholders' equity (Reclassifications out of AOCI) (Details) - USD ($) $ in Millions	3 Months Ended						9 Months Ended
	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Sep. 30, 2019	Sep. 30, 2018
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Interest and other income, net	$ 114			$ 126			$ 517	$ 519
Income before income taxes	2,277			2,094			7,155	7,360
Provision for income taxes	(309)			(235)			(1,016)	(894)
Net income	1,968	$ 2,179	$ 1,992	1,859	$ 2,296	$ 2,311	6,139	6,466
Product sales [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	5,463			5,510			16,323	16,532
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	(38)			(33)			(30)	(221)
Provision for income taxes	8			7			6	47
Net income	(30)			(26)			(24)	(174)
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	(3)			(103)			(9)	(352)
Provision for income taxes	0			1			0	3
Net income	(3)			(102)			(9)	(349)
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Foreign currency contract [Member] \| Cash flow hedges [Member] \| Product sales [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	26			3			62	(51)
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Cross-currency swap contract [Member] \| Cash flow hedges [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Interest and other income, net	(64)			(36)			(92)	(170)
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Cash flow hedges [Member] \| Foreign currency contract [Member] \| Cash flow hedges [Member] \| Product sales [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	26			3			62	(51)
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	$ (64)			$ (36)			$ (92)	$ (170)