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Stockholders' equity (Reclassifications out of AOCI) (Details) - USD ($)
$ in Millions
3 Months Ended
Mar. 31, 2020
Mar. 31, 2019
Reclassification out of Accumulated Other Comprehensive Income [Line Items]    
Interest and other income, net $ 11 $ 185
Income before income taxes 2,020 2,314
Provision for income taxes (195) (322)
Net income 1,825 1,992
Product sales [Member]    
Reclassification out of Accumulated Other Comprehensive Income [Line Items]    
Product sales 5,894 5,286
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 (84) (28)
Provision for income taxes 18 6
Net income (66) (22)
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 33 (4)
Provision for income taxes (7) 0
Net income 26 (4)
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 49 14
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 (133) (42)
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 49 14
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 $ (133) $ (42)