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Consolidated Statement of Cash Flows - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2018
Dec. 31, 2017
Dec. 31, 2016
Cash Flows from Operating Activities      
Net income $ 6,193 $ 2,418 $ 3,941
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 4,519 4,676 5,471
Intangible asset impairment charges 296 646 3,948
Charge for future payments related to collaboration license options 650 500 0
Provisional charge for one-time transition tax related to the enactment of U.S. tax legislation 0 5,347 0
Charge related to the settlement of worldwide Keytruda patent litigation 0 0 625
Deferred income taxes (509) (2,621) (1,521)
Share-based compensation 348 312 300
Other 978 190 213
Net changes in assets and liabilities:      
Accounts receivable (418) 297 (619)
Inventories (911) (145) 206
Trade accounts payable 230 254 278
Accrued and other current liabilities (341) (922) (2,018)
Income taxes payable 827 (3,291) 124
Noncurrent liabilities (266) (123) (809)
Other (674) (1,087) 237
Net Cash Provided by Operating Activities 10,922 6,451 10,376
Cash Flows from Investing Activities      
Capital expenditures (2,615) (1,888) (1,614)
Purchases of securities and other investments (7,994) (10,739) (15,651)
Proceeds from sales of securities and other investments 15,252 15,664 14,353
Acquisitions, net of cash acquired (431) (396) (780)
Other 102 38 482
Net Cash Provided by (Used in) Investing Activities 4,314 2,679 (3,210)
Cash Flows from Financing Activities      
Net change in short-term borrowings 5,124 (26) 0
Payments on debt (4,287) (1,103) (2,386)
Proceeds from issuance of debt 0 0 1,079
Purchases of treasury stock (9,091) (4,014) (3,434)
Dividends paid to stockholders (5,172) (5,167) (5,124)
Proceeds from exercise of stock options 591 499 939
Other (325) (195) (118)
Net Cash Used in Financing Activities (13,160) (10,006) (9,044)
Effect of Exchange Rate Changes on Cash, Cash Equivalents and Restricted Cash (205) 457 (131)
Net Increase (Decrease) in Cash, Cash Equivalents and Restricted Cash 1,871 (419) (2,009)
Cash, Cash Equivalents and Restricted Cash at Beginning of Year (includes $4 million of restricted cash at January 1, 2018 included in Other Assets) 6,096 6,515 8,524
Cash, Cash Equivalents and Restricted Cash at End of Year (includes $2 million of restricted cash at December 31, 2018 included in Other Assets) $ 7,967 $ 6,096 $ 6,515