CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Operating Activities:
Net income:	$ 5,613	$ 4,566	$ 6,201
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation expense	354	323	329
Amortization expense	2,339	1,780	1,721
Stock-based compensation expense	766	637	635
Deferred income taxes	(962)	(1,552)	(116)
Net loss from equity securities	167	657	610
Acquired in-process research and development expenses	1,155	944	939
In-process research and development impairments	50	2,700	0
Other	826	780	576
Changes in operating assets and liabilities:
Accounts receivable, net	157	(406)	313
Inventories	(842)	(310)	11
Prepaid expenses and other	39	(134)	(45)
Accounts payable	(347)	226	(118)
Income tax assets and liabilities, net	(1,768)	(364)	(361)
Accrued and other liabilities	458	(775)	689
Net cash provided by operating activities	8,006	9,072	11,384
Investing Activities:
Purchases of marketable debt securities	(1,930)	(1,770)	(3,517)
Proceeds from sales of marketable debt securities	510	412	730
Proceeds from maturities of marketable debt securities	1,334	1,590	2,180
Acquisitions, including in-process research and development, net of cash acquired	(1,152)	(1,797)	(1,584)
Purchases of equity securities	(442)	(172)	(380)
Capital expenditures	(585)	(728)	(579)
Other	(1)	(1)	19
Net cash used in investing activities	(2,265)	(2,466)	(3,131)
Financing Activities:
Proceeds from debt financing, net of issuance costs	1,980	0	0
Proceeds from issuances of common stock	232	309	169
Repurchases of common stock under repurchase programs	(1,000)	(1,396)	(546)
Repayments of debt and other obligations	(2,250)	(1,500)	(4,750)
Payments of dividends	(3,809)	(3,709)	(3,605)
Other	(279)	(173)	(145)
Net cash used in financing activities	(5,125)	(6,469)	(8,877)
Effect of exchange rate changes on cash and cash equivalents	57	(63)	(35)
Net change in cash and cash equivalents	673	74	(659)
Cash and cash equivalents at beginning of period	5,412	5,338	5,997
Cash and cash equivalents at end of period	6,085	5,412	5,338
Supplemental disclosure of cash flow information:
Interest paid, net of amounts capitalized	891	907	979
Income taxes paid	$ 3,990	$ 3,136	$ 2,509