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Income Taxes, Reconciliation of Statutory to Effective Tax Rate (Details) - USD ($) $ in Thousands	3 Months Ended	12 Months Ended
	Dec. 31, 2018	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Reconciliation Between Effective and Statutory Tax Rate [Abstract]
Pre-tax income (loss)		$ 346,769	$ (76,156)	$ (16,763)
Statutory rate		72,822	(15,993)	(5,867)
State income tax net of federal benefit		49,119	(2,202)	820
Foreign		340	1,735	4,299
Net change in valuation allowance	$ 332,100	(37,765)	(277,924)	(86,296)
Net operating loss expiration		0	8,864	3,987
TEGSEDI licensing gain		0	59,583	0
Impact from outside basis differences		(16,344)	0	0
Tax credits		(22,296)	(73,362)	(32,769)
Deferred tax true-up		646	9,947	4,848
Tax rate change		1,811	(1,808)	114,832
Non-deductible compensation		3,361	3,154	1,575
Other non-deductible items		329	(569)	2,548
Akcea deconsolidation adjustment at IPO		0	0	469
Stock-based compensation		(4,837)	(4,199)	(14,337)
Foreign-derived intangible income benefit		(2,071)	0	0
Other		(1,608)	1,633	(89)
Income tax expense (benefit)		$ 43,507	$ (291,141)	$ (5,980)
Reconciliation Between Effective and Statutory Tax Rate Percentage [Abstract]
Statutory rate		21.00%	21.00%	35.00%
State income tax net of federal benefit		14.20%	2.90%	(4.90%)
Foreign		0.10%	(2.30%)	(25.60%)
Net change in valuation allowance		(10.90%)	364.90%	514.80%
Net operating loss expiration		0.00%	(11.60%)	(23.80%)
TEGSEDI licensing gain		0.00%	(78.20%)	0.00%
Impact from outside basis differences		(4.70%)	0.00%	0.00%
Tax credits		(6.40%)	96.30%	195.50%
Deferred tax true-up		0.20%	(13.10%)	(28.90%)
Tax rate change		0.50%	2.40%	(685.00%)
Non-deductible compensation		1.00%	(4.10%)	(9.40%)
Other nondeductible items		0.10%	0.70%	(15.20%)
Akcea deconsolidation adjustment at IPO		0.00%	0.00%	(2.80%)
Stock-based compensation		(1.40%)	5.50%	85.50%
Foreign-derived intangible income benefit		(0.60%)	0.00%	0.00%
Other		(0.50%)	(2.10%)	0.50%
Effective rate		12.60%	382.30%	35.70%

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