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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
 6 Months Ended
Jun. 30, 2023
Jun. 30, 2022
Operating Activities:    
Net income $ 2,024 $ 1,147
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation expense 177 160
Amortization expense 1,144 890
Stock-based compensation expense 363 295
Acquired in-process research and development expenses 717 338
In-process research and development impairment 0 2,700
Deferred income taxes (524) (944)
Net loss from equity securities 187 399
Other 205 420
Changes in operating assets and liabilities:    
Accounts receivable, net 549 247
Inventories (453) 61
Prepaid expenses and other 66 (81)
Accounts payable (275) (104)
Income tax assets and liabilities, net (189) (591)
Accrued and other liabilities 91 (1,295)
Net cash provided by operating activities 4,082 3,642
Investing Activities:    
Purchases of marketable debt securities (1,105) (1,090)
Proceeds from sales of marketable debt securities 317 323
Proceeds from maturities of marketable debt securities 719 955
Acquisitions, including in-process research and development, net of cash acquired (794) (1,131)
Purchases of equity securities (192) (44)
Capital expenditures (248) (390)
Other (6) (1)
Net cash used in investing activities (1,309) (1,378)
Financing Activities:    
Proceeds from issuances of common stock 123 97
Repurchases of common stock under repurchase programs (550) (424)
Repayments of debt and other obligations 0 (500)
Payments of dividends (1,913) (1,865)
Other (167) (105)
Net cash used in financing activities (2,507) (2,797)
Effect of exchange rate changes on cash and cash equivalents 26 (66)
Net change in cash and cash equivalents 292 (599)
Cash and cash equivalents at beginning of period 5,412 5,338
Cash and cash equivalents at end of period $ 5,704 $ 4,739