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Stockholders' equity (Reclassifications out of AOCI) (Details) - USD ($) $ in Millions	3 Months Ended				6 Months Ended
	Jun. 30, 2020	Mar. 31, 2020	Jun. 30, 2019	Mar. 31, 2019	Jun. 30, 2020	Jun. 30, 2019
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Interest and other income, net	$ 3		$ 218		$ 14	$ 403
Income before income taxes	2,030		2,564		4,050	4,878
Provision for income taxes	(227)		(385)		(422)	(707)
Net income	1,803	$ 1,825	2,179	$ 1,992	3,628	4,171
Product sales [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	5,908		5,574		11,802	10,860
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Cash flow hedges [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Income before income taxes	119		36		35	8
Provision for income taxes	(26)		(8)		(8)	(2)
Net income	93		28		27	6
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Available-for-sale securities [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Interest and other income, net	0		(2)		33	(6)
Provision for income taxes	0		0		(7)	0
Net income	0		(2)		26	(6)
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Foreign currency contract [Member] \| Cash flow hedges [Member] \| Product sales [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	68		22		117	36
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Cross-currency swap contract [Member] \| Cash flow hedges [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Interest and other income, net	51		14		(82)	(28)
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Cash flow hedges [Member] \| Foreign currency contract [Member] \| Cash flow hedges [Member] \| Product sales [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	68		22		117	36
Reclassification out of Accumulated Other Comprehensive Income [Member] \| Cash flow hedges [Member] \| Cross-currency swap contract [Member] \| Cash flow hedges [Member]
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Interest and other income, net	$ 51		$ 14		$ (82)	$ (28)