Stockholders' equity - Reclassifications Out of AOCI (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Gross product sales	$ 28,190	$ 26,323	$ 25,979
Other income (expense), net	2,833	(814)	259
Income before income taxes	7,855	7,346	6,701
Provision for income taxes	(1,138)	(794)	(808)
Net income	6,717	6,552	5,893
Product sales
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Gross product sales	26,910	24,801	24,297
Reclassification out of AOCI | Cash flow hedges
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Income before income taxes	222	(2)	(253)
Provision for income taxes	(50)	0	55
Net income	172	(2)	(198)
Reclassification out of AOCI | Foreign currency contract gains (losses) | Product sales | Cash flow hedges
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Gross product sales	180	231	(8)
Reclassification out of AOCI | Cross-currency swap contract gains (losses) | Cash flow hedges
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Other income (expense), net	$ 42	$ (233)	$ (245)