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Stockholders' equity (Reclassifications out of AOCI) (Details) - USD ($) $ in Millions	3 Months Ended								12 Months Ended
	Dec. 31, 2019	Sep. 30, 2019	Jun. 30, 2019	Mar. 31, 2019	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Revenues									$ 23,362	$ 23,747	$ 22,849
Interest and other income, net									753	674	928
Interest expense, net									(1,289)	(1,392)	(1,304)
Income before income taxes									9,138	9,545	9,597
Provision for income taxes									(1,296)	(1,151)	(7,618)
Net income	$ 1,703	$ 1,968	$ 2,179	$ 1,992	$ 1,928	$ 1,859	$ 2,296	$ 2,311	7,842	8,394	1,979
Product sales [Member]
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Revenues	$ 5,881	$ 5,463	$ 5,574	$ 5,286	$ 6,001	$ 5,510	$ 5,679	$ 5,343	22,204	22,533	21,795
Reclassification out of AOCI [Member] \| Cash flow hedges [Member]
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Income before income taxes									211	(262)	638
Provision for income taxes									(46)	55	(226)
Net income									165	(207)	412
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									56	(365)	(41)
Provision for income taxes									(14)	3	(8)
Net income									42	(362)	(49)
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									101	(21)	65
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									101	(21)	65
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									110	(241)	574
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									110	(241)	574
Reclassification out of AOCI [Member] \| Forward interest rate contract [Member] \| Cash flow hedges [Member]
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Interest expense, net											(1)
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	$ 0	$ (1)