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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
 3 Months Ended
Mar. 31, 2021
Mar. 31, 2020
Operating Activities:    
Net income $ 1,722 $ 1,538
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation expense 78 68
Amortization expense 395 281
Stock-based compensation expense 139 141
Acquired in-process research and development expenses 62 97
Deferred income taxes 71 56
Net losses from equity securities 351 283
Other 201 73
Changes in operating assets and liabilities:    
Accounts receivable, net 975 (376)
Inventories (69) 15
Prepaid expenses and other (8) 46
Accounts payable (253) (109)
Income taxes payable (316) (127)
Accrued and other liabilities (738) (550)
Net cash provided by operating activities 2,610 1,436
Investing Activities:    
Purchases of marketable debt securities (931) (13,158)
Proceeds from sales of marketable debt securities 60 9,656
Proceeds from maturities of marketable debt securities 619 3,449
Acquisitions, including in-process research and development, net of cash acquired (1,255) (63)
Purchases of equity securities (279) (8)
Capital expenditures (165) (171)
Other (91) (49)
Net cash used in investing activities (2,042) (344)
Financing Activities:    
Proceeds from issuances of common stock 88 177
Repurchases of common stock (309) (1,328)
Repayments of debt and other obligations (1,250) (500)
Payments of dividends (917) (874)
Other (89) (86)
Net cash used in financing activities (2,477) (2,611)
Effect of exchange rate changes on cash and cash equivalents (23) (61)
Net change in cash and cash equivalents (1,932) (1,580)
Cash and cash equivalents at beginning of period 5,997 11,631
Cash and cash equivalents at end of period $ 4,065 $ 10,051