Stockholders' equity (Reclassifications out of AOCI) (Details) - USD ($) $ in Millions	3 Months Ended						9 Months Ended
	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2021	Jun. 30, 2021	Mar. 31, 2021	Sep. 30, 2022	Sep. 30, 2021
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Total revenues	$ 6,652			$ 6,706			$ 19,484	$ 19,133
Other income (expense), net	100			73			(747)	97
Income before income taxes	2,392			2,155			5,598	4,570
Provision for income taxes	(249)			(271)			(662)	(576)
Net income	2,143	$ 1,317	$ 1,476	1,884	$ 464	$ 1,646	4,936	3,994
Product sales
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Total revenues	6,237			6,320			18,249	18,026
Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Income before income taxes	(129)			(109)			(312)	(214)
Provision for income taxes	28			23			67	45
Net income	(101)			(86)			(245)	(169)
Reclassification out of Accumulated Other Comprehensive Income | Foreign currency contract gains (losses) | Cash flow hedges | Product sales
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Total revenues	69			(5)			149	(24)
Reclassification out of Accumulated Other Comprehensive Income | Cross-currency swap contract losses | Cash flow hedges
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Other income (expense), net	(198)			(104)			(461)	(190)
Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges | Foreign currency contract gains (losses) | Cash flow hedges | Product sales
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Total revenues	69			(5)			149	(24)
Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges | Cross-currency swap contract losses | Cash flow hedges
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Other income (expense), net	$ (198)			$ (104)			$ (461)	$ (190)