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Derivative instruments (Locations and Effective Portions of Gain (Loss) Reclassified out of AOCI) (Details) - USD ($) $ in Millions	3 Months Ended								12 Months Ended
	Dec. 31, 2018	Sep. 30, 2018	Jun. 30, 2018	Mar. 31, 2018	Dec. 31, 2017	Sep. 30, 2017	Jun. 30, 2017	Mar. 31, 2017	Dec. 31, 2018	Dec. 31, 2017	Dec. 31, 2016
Derivative Instruments Gain Loss [Line Items]
Interest and other income, net									$ 674	$ 928	$ 629
Interest expense, net									(1,392)	(1,304)	(1,260)
Income before income taxes									9,545	9,597	9,163
Product sales [Member]
Derivative Instruments Gain Loss [Line Items]
Product sales	$ 6,001	$ 5,510	$ 5,679	$ 5,343	$ 5,569	$ 5,453	$ 5,574	$ 5,199	22,533	21,795	21,892
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									(262)	638	(139)
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Foreign currency contracts [Member] | Product sales [Member]
Derivative Instruments Gain Loss [Line Items]
Product sales									(21)
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cross-currency swap contracts [Member]
Derivative Instruments Gain Loss [Line Items]
Interest and other income, net									(241)
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									(262)	638	(139)
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] | Product sales [Member]
Derivative Instruments Gain Loss [Line Items]
Product sales									(21)	65	308
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									(241)	574	(446)
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedge [Member] | Forward interest rate contracts [Member]
Derivative Instruments Gain Loss [Line Items]
Interest expense, net									$ 0	$ (1)	$ (1)

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