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Stockholders' equity (Reclassifications out of AOCI) (Details) - USD ($)
$ in Millions
 3 Months Ended 9 Months Ended
Sep. 30, 2017
Sep. 30, 2016
Sep. 30, 2017
Sep. 30, 2016
Reclassification out of Accumulated Other Comprehensive Income [Line Items]        
Product sales $ 5,453 $ 5,516 $ 16,226 $ 16,229
Interest and other income, net 267 216 627 503
Interest expense, net (325) (325) (972) (932)
Total before income tax 2,381 2,418 7,383 6,880
Tax expense (360) (401) (1,140) (1,093)
Net of taxes 2,021 2,017 6,243 5,787
Reclassification out of Accumulated Other Comprehensive Income [Member] | Accumulated net gain (loss) from cash flow hedges [Member]        
Reclassification out of Accumulated Other Comprehensive Income [Line Items]        
Total before income tax 140 65 601 98
Tax expense (49) (27) (213) (39)
Net of taxes 91 38 388 59
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 26 23 (70) (30)
Tax expense (5) (8) (7) 0
Net of taxes 21 15 (77) (30)
Cash flow hedge [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Accumulated net gain (loss) from cash flow hedges [Member]        
Reclassification out of Accumulated Other Comprehensive Income [Line Items]        
Total before income tax 140 65 601 98
Cash flow hedge [Member] | Foreign currency contracts [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Accumulated net gain (loss) from cash flow hedges [Member]        
Reclassification out of Accumulated Other Comprehensive Income [Line Items]        
Product sales (2) 67 88 242
Cash flow hedge [Member] | Cross currency swap contracts [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Accumulated net gain (loss) from cash flow hedges [Member]        
Reclassification out of Accumulated Other Comprehensive Income [Line Items]        
Interest and other income, net 143 (1) 514 (143)
Cash flow hedge [Member] | Forward interest rate contract [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Accumulated net gain (loss) from cash flow hedges [Member]        
Reclassification out of Accumulated Other Comprehensive Income [Line Items]        
Interest expense, net $ (1) $ (1) $ (1) $ (1)