Stockholders' equity - Reclassifications Out of Accumulated Other Comprehensive Income (Details) - USD ($) $ in Millions	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	$ 8,503			$ 6,903			$ 24,338	$ 19,994
Other income, net	1,830			685			1,288	2,431
Income before income taxes	3,101			1,947			3,827	7,003
Provision for income taxes	(271)			(217)			(364)	(1,053)
Net income	2,830	$ 746	$ (113)	1,730	$ 1,379	$ 2,841	3,463	5,950
Product sales
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	8,151			6,548			23,310	19,077
Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Income before income taxes	166			(53)			238	64
Provision for income taxes	(36)			11			(51)	(14)
Net income	130			(42)			187	50
Reclassification out of Accumulated Other Comprehensive Income | Foreign currency contract gains | Cash flow hedges | Product sales
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	45			33			151	121
Reclassification out of Accumulated Other Comprehensive Income | Cross-currency swap contract gains (losses) | Cash flow hedges
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Other income, net	121			(86)			87	(57)
Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges | Foreign currency contract gains | Cash flow hedges | Product sales
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Product sales	45			33			151	121
Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges | Cross-currency swap contract gains (losses) | Cash flow hedges
Reclassification out of Accumulated Other Comprehensive Income [Line Items]
Other income, net	$ 121			$ (86)			$ 87	$ (57)