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Quarterly financial data (unaudited) (Details) - USD ($) $ / shares in Units, $ 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
Effect of Fourth Quarter Events [Line Items]
Gross profit from product sales	$ 4,905	$ 4,473	$ 4,655	$ 4,399	$ 4,510	$ 4,463	$ 4,550	$ 4,203
Net income	$ 1,928	$ 1,859	$ 2,296	$ 2,311	$ (4,264)	$ 2,021	$ 2,151	$ 2,071	$ 8,394	$ 1,979	$ 7,722
Earnings per share:
Basic (in usd per share)	$ 3.04	$ 2.88	$ 3.50	$ 3.27	$ (5.89)	$ 2.78	$ 2.93	$ 2.81	$ 12.70	$ 2.71	$ 10.32
Diluted (in usd per share)	$ 3.01	$ 2.86	$ 3.48	$ 3.25	$ (5.89)	$ 2.76	$ 2.91	$ 2.79	$ 12.62	$ 2.69	$ 10.24
Product [Member]
Effect of Fourth Quarter Events [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

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