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Goodwill and other intangible assets - Narrative (Details) - USD ($)
$ in Millions
 3 Months Ended 9 Months Ended
Sep. 30, 2023
Sep. 30, 2022
Sep. 30, 2023
Sep. 30, 2022
Indefinite-lived Intangible Assets [Line Items]        
Amortization charges associated with finite-lived intangible assets $ 693 $ 628 $ 2,100 $ 1,900
Total estimated amortization of finite-lived intangible assets for the remainder of the year 700   700  
Total estimated amortization of finite-lived intangible assets for year one 2,700   2,700  
Total estimated amortization of finite-lived intangible assets for year two 2,500   2,500  
Total estimated amortization of finite-lived intangible assets for year three 2,100   2,100  
Total estimated amortization of finite-lived intangible assets for year four 2,100   2,100  
Total estimated amortization of finite-lived intangible assets for year five $ 1,100   $ 1,100  
Impairment, Intangible Asset, Indefinite-Lived (Excluding Goodwill), Statement of Income or Comprehensive Income [Extensible Enumeration] Other      
In-process research and development        
Indefinite-lived Intangible Assets [Line Items]        
Impairment of Intangible Assets, Indefinite-Lived (Excluding Goodwill) $ 783