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Goodwill and intangible assets (Identifiable Intangible Assets) (Details) - USD ($)
$ in Millions
Dec. 31, 2018
Dec. 31, 2017
Finite-lived intangible assets:    
Gross carrying amounts $ 18,790 $ 18,344
Accumulated amortization (11,402) (10,121)
Other intangible assets, net 7,388 8,223
Indefinite-lived intangible assets:    
Identifiable intangible assets 18,845 18,730
Accumulated amortization (11,402) (10,121)
Identifiable intangible assets, net 7,443 8,609
IPR&D [Member]    
Indefinite-lived intangible assets:    
Indefinite-lived intangible assets 55 386
Developed product technology rights [Member]    
Finite-lived intangible assets:    
Gross carrying amounts 12,573 12,589
Accumulated amortization (7,479) (6,796)
Other intangible assets, net 5,094 5,793
Licensing rights [Member]    
Finite-lived intangible assets:    
Gross carrying amounts 3,772 3,275
Accumulated amortization (2,032) (1,601)
Other intangible assets, net 1,740 1,674
Marketing-related rights [Member]    
Finite-lived intangible assets:    
Gross carrying amounts 1,297 1,319
Accumulated amortization (1,019) (920)
Other intangible assets, net 278 399
R&D technology rights [Member]    
Finite-lived intangible assets:    
Gross carrying amounts 1,148 1,161
Accumulated amortization (872) (804)
Other intangible assets, net $ 276 $ 357