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Income Tax Expense Reconciliation (Detail) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2017
Dec. 31, 2016
Dec. 31, 2015
Income Tax Expense Reconciliation      
Income tax expense at U.S. statutory rate $ 424 $ 1,734 $ 150
Retained shares tax free exchange gains   (1,587)  
Tax incentives (140) (126) (133)
State and local taxes (6) 1 (13)
Foreign tax expense (benefit) (80) 5 11
Valuation allowances 4 3 5
Contingent tax matters (1) (48) 9
Branded Prescription Drug Fee   1 1
Deferred tax charge on intangible intra-group transfers 14 13 14
R&D tax credit (4) (2) (4)
Puerto Rico excise tax credit (2) (5) (9)
Deferred Tax Revaluation due to 2017 Tax Act (283)    
Transition Tax due to 2017 Tax Act 529    
U.S. Valuation Allowance due to 2017 Tax Act 339    
Stock options windfall tax benefits (56)    
Foreign tax credits generated (246)    
Other factors 1 (1) 4
Income tax expense (benefit) $ 493 $ (12) $ 35