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Stockholders' equity (Reclassifications out of AOCI) (Details) - USD ($)
$ in Millions
 3 Months Ended 9 Months Ended
Sep. 30, 2021
Jun. 30, 2021
Mar. 31, 2021
Sep. 30, 2020
Jun. 30, 2020
Mar. 31, 2020
Sep. 30, 2021
Sep. 30, 2020
Reclassification out of Accumulated Other Comprehensive Income [Line Items]                
Total revenues $ 6,706     $ 6,423     $ 19,133 $ 18,790
Other income, net 73     55     97 69
Income before income taxes 2,155     2,206     4,570 6,256
Provision for income taxes (271)     (185)     (576) (607)
Net income 1,884 $ 464 $ 1,646 2,021 $ 1,803 $ 1,825 3,994 5,649
Product sales [Member]                
Reclassification out of Accumulated Other Comprehensive Income [Line Items]                
Total revenues 6,320     6,104     18,026 17,906
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 (109)     224     (214) 259
Provision for income taxes 23     (49)     45 (57)
Net income (86)     175     (169) 202
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]                
Total revenues (5)     41     (24) 158
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 (104)     183     (190) 101
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]                
Total revenues (5)     41     (24) 158
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 $ (104)     $ 183     $ (190) $ 101