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Stockholders' equity (Reclassifications out of AOCI) (Details) - USD ($) $ in Millions	3 Months Ended				6 Months Ended
	Jun. 30, 2019	Mar. 31, 2019	Jun. 30, 2018	Mar. 31, 2018	Jun. 30, 2019	Jun. 30, 2018
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Interest and other income, net	$ 218		$ 162		$ 403	$ 393
Income before income taxes	2,564		2,647		4,878	5,266
Provision for income taxes	(385)		(351)		(707)	(659)
Net income	2,179	$ 1,992	2,296	$ 2,311	4,171	4,607
Product sales [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	5,574		5,679		10,860	11,022
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Cash flow hedges [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Income before income taxes	36		(318)		8	(188)
Provision for income taxes	(8)		68		(2)	40
Net income	28		(250)		6	(148)
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	(2)		(115)		(6)	(249)
Provision for income taxes	0		1		0	2
Net income	(2)		(114)		(6)	(247)
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Foreign currency contract [Member] \| Cash flow hedges [Member] \| Product sales [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	22		(20)		36	(54)
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Cross-currency swap contract [Member] \| Cash flow hedges [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Interest and other income, net	14		(298)		(28)	(134)
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Cash flow hedges [Member] \| Foreign currency contract [Member] \| Cash flow hedges [Member] \| Product sales [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	22		(20)		36	(54)
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Cash flow hedges [Member] \| Cross-currency swap contract [Member] \| Cash flow hedges [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Interest and other income, net	$ 14		$ (298)		$ (28)	$ (134)