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Goodwill and other intangible assets - Identifiable Intangible Assets (Details) - USD ($)
$ in Millions
Sep. 30, 2023
Dec. 31, 2022
Finite-Lived Intangible Assets [Line Items]    
Gross carrying amounts $ 35,608 $ 35,596
Accumulated amortization (22,616) (20,525)
Other intangible assets, net 12,992 15,071
Gross carrying amount 35,766 36,605
Accumulated amortization (22,616) (20,525)
Intangible assets, net 13,150 16,080
In-process research and development    
Indefinite-lived Intangible Assets [Line Items]    
Indefinite-lived intangible assets: 158 1,009
Developed-product-technology rights    
Finite-Lived Intangible Assets [Line Items]    
Gross carrying amounts 29,028 29,028
Accumulated amortization (16,931) (15,045)
Other intangible assets, net 12,097 13,983
Licensing rights    
Finite-Lived Intangible Assets [Line Items]    
Gross carrying amounts 3,864 3,864
Accumulated amortization (3,233) (3,123)
Other intangible assets, net 631 741
Marketing-related rights    
Finite-Lived Intangible Assets [Line Items]    
Gross carrying amounts 1,339 1,326
Accumulated amortization (1,243) (1,167)
Other intangible assets, net 96 159
Research and development technology rights    
Finite-Lived Intangible Assets [Line Items]    
Gross carrying amounts 1,377 1,378
Accumulated amortization (1,209) (1,190)
Other intangible assets, net $ 168 $ 188