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Derivative instruments (Locations and Effective Portions of Gain (Loss) Reclassified out of AOCI) (Details) - USD ($) $ in Millions | 3 Months Ended
--- | ---
Mar. 31, 2018 | Mar. 31, 2017
Derivative Instruments Gain Loss [Line Items] |  |
Product sales | $ 5,343 | $ 5,199
Interest and other income, net | 231 | 195
Income before income taxes | 2,619 | 2,460
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] |  |
Derivative Instruments Gain Loss [Line Items] |  |
Income before income taxes | 130 | 131
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedge [Member] |  |
Derivative Instruments Gain Loss [Line Items] |  |
Income before income taxes | 130 | 131
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedge [Member] | Foreign currency contracts [Member] |  |
Derivative Instruments Gain Loss [Line Items] |  |
Product sales | (34) | 57
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedge [Member] | Cross-currency swap contracts [Member] |  |
Derivative Instruments Gain Loss [Line Items] |  |
Interest and other income, net | $ 164 | $ 74

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