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Stockholders' equity (Reclassifications out of AOCI) (Details) - USD ($)
$ in Millions
 3 Months Ended 6 Months Ended
Jun. 30, 2023
Mar. 31, 2023
Jun. 30, 2022
Mar. 31, 2022
Jun. 30, 2023
Jun. 30, 2022
Reclassification out of Accumulated Other Comprehensive Income [Line Items]            
Total revenues $ 6,986   $ 6,594   $ 13,091 $ 12,832
Other (expense) income, net (318)   (317)   1,746 (847)
Income before income taxes 1,614   1,531   5,056 3,206
Provision for income taxes (235)   (214)   (836) (413)
Net income 1,379 $ 2,841 1,317 $ 1,476 4,220 2,793
Product sales            
Reclassification out of Accumulated Other Comprehensive Income [Line Items]            
Total revenues 6,683   6,281   12,529 12,012
Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges            
Reclassification out of Accumulated Other Comprehensive Income [Line Items]            
Income before income taxes 87   (132)   117 (183)
Provision for income taxes (19)   28   (25) 39
Net income 68   (104)   92 (144)
Reclassification out of Accumulated Other Comprehensive Income | Foreign currency contract gains | Cash flow hedges | Product sales            
Reclassification out of Accumulated Other Comprehensive Income [Line Items]            
Total revenues 36   53   88 80
Reclassification out of Accumulated Other Comprehensive Income | Cross-currency swap contract gains (losses) | Cash flow hedges            
Reclassification out of Accumulated Other Comprehensive Income [Line Items]            
Other (expense) income, net 51   (185)   29 (263)
Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges | Foreign currency contract gains | Cash flow hedges | Product sales            
Reclassification out of Accumulated Other Comprehensive Income [Line Items]            
Total revenues 36   53   88 80
Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges | Cross-currency swap contract gains (losses) | Cash flow hedges            
Reclassification out of Accumulated Other Comprehensive Income [Line Items]            
Other (expense) income, net $ 51   $ (185)   $ 29 $ (263)