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Stockholders' equity (Reclassifications out of AOCI) (Details) - USD ($)
$ in Millions
 3 Months Ended 12 Months Ended
Dec. 31, 2020
Sep. 30, 2020
Jun. 30, 2020
Mar. 31, 2020
Dec. 31, 2019
Sep. 30, 2019
Jun. 30, 2019
Mar. 31, 2019
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Revenues                 $ 25,424 $ 23,362 $ 23,747
Interest and other income, net                 256 753 674
Interest expense, net                 (1,262) (1,289) (1,392)
Income before income taxes                 8,133 9,138 9,545
Provision for income taxes                 (869) (1,296) (1,151)
Net income $ 1,615 $ 2,021 $ 1,803 $ 1,825 $ 1,703 $ 1,968 $ 2,179 $ 1,992 7,264 7,842 8,394
Product sales [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Revenues $ 6,334 $ 6,104 $ 5,908 $ 5,894 $ 5,881 $ 5,463 $ 5,574 $ 5,286 24,240 22,204 22,533
Reclassification out of AOCI [Member] | Cash flow hedges [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Income before income taxes                 501 211 (262)
Provision for income taxes                 (110) (46) 55
Net income                 391 165 (207)
Reclassification out of AOCI [Member] | Available-for-sale securities [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Interest and other income, net                 33 56 (365)
Provision for income taxes                 (7) (14) 3
Net income                 26 42 (362)
Reclassification out of AOCI [Member] | Foreign currency contract [Member] | Product sales [Member] | Cash flow hedges [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Revenues                 178 101 (21)
Reclassification out of AOCI [Member] | Foreign currency contract [Member] | Cash flow hedge [Member] | Product sales [Member] | Cash flow hedges [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Revenues                 178 101 (21)
Reclassification out of AOCI [Member] | Cross-currency swap contract [Member] | Cash flow hedges [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Interest and other income, net                 323 110 (241)
Reclassification out of AOCI [Member] | Cross-currency swap contract [Member] | Cash flow hedge [Member] | Cash flow hedges [Member]                      
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]                      
Interest and other income, net                 $ 323 $ 110 $ (241)