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Stockholders' equity (Reclassifications out of AOCI) (Details) - USD ($) $ in Millions	3 Months Ended				6 Months Ended
	Jun. 30, 2021	Mar. 31, 2021	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2021	Jun. 30, 2020
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Other income, net	$ 11		$ 3		$ 24	$ 14
Income before income taxes	558		2,030		2,415	4,050
Provision for income taxes	(94)		(227)		(305)	(422)
Net income	464	$ 1,646	1,803	$ 1,825	2,110	3,628
Product sales [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	6,114		5,908		11,706	11,802
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	28		119		(105)	35
Provision for income taxes	(6)		(26)		22	(8)
Net income	22		93		(83)	27
Reclassification out of Accumulated Other Comprehensive Income [Member] | Available-for-sale securities [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Other income, net	0		0		0	33
Provision for income taxes	0		0		0	(7)
Net income	0		0		0	26
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	(18)		68		(19)	117
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]
Other income, net	46		51		(86)	(82)
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	(18)		68		(19)	117
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]
Other income, net	$ 46		$ 51		$ (86)	$ (82)

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